ro13-9904 and Fetal-Membranes--Premature-Rupture

Topics: Adult; Amikacin; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; Ceftriaxone; Cesarean Section; Drug Resistance, Bacterial; Endometritis; Escherichia coli; Escherichia coli Infections; Female; Fetal Membranes, Premature Rupture; Humans; India; Nucleic Acid Amplification Techniques; Ontario; Pregnancy; Pregnancy, Twin; Puerperal Infection; Travel

Antibiotic administration is a standard practice in preterm premature rupture of membranes (PROM). Specific anti-microbial agents often include ampicillin and/or erythromycin. Anaerobes and genital mycoplasmas are frequently involved in preterm PROM, but are not adequately covered by antibiotics routinely used in clinical practice. Our objective was to compare outcomes of PROM treated with standard antibiotic administration versus a new combination more effective against these bacteria.. A retrospective study compared perinatal outcomes in 314 patients with PROM <34 weeks receiving anti-microbial regimen 1 (ampicillin and/or cephalosporins; n = 195, 1993-2003) versus regimen 2 (ceftriaxone, clarithromycin and metronidazole; n = 119, 2003-2012). Intra-amniotic infection/inflammation was assessed by positive amniotic fluid culture and/or an elevated amniotic fluid MMP-8 concentration (>23 ng/mL).. (1) Patients treated with regimen 2 had a longer median antibiotic-to-delivery interval than those with regimen 1 [median (interquartile range) 23 d (10-51 d) versus 12 d (5-52 d), p < 0.01]; (2) patients who received regimen 2 had lower rates of acute histologic chorioamnionitis (50.5% versus 66.7%, p < 0.05) and funisitis (13.9% versus 42.9%, p < 0.001) than those who had received regimen 1; (3) the rates of intra-ventricular hemorrhage (IVH) and cerebral palsy (CP) were significantly lower in patients allocated to regimen 2 than regimen 1 (IVH: 2.1% versus 19.0%, p < 0.001 and CP: 0% versus 5.7%, p < 0.05); and (4) subgroup analysis showed that regimen 2 improved perinatal outcomes in pregnancies with intra-amniotic infection/inflammation, but not in those without intra-amniotic infection/inflammation (after adjusting for gestational age and antenatal corticosteroid administration).. A new antibiotic combination consisting of ceftriaxone, clarithromycin, and metronidazole prolonged the latency period, reduced acute histologic chorioamnionitis/funisitis, and improved neonatal outcomes in patients with preterm PROM. These findings suggest that the combination of anti-microbial agents (ceftriaxone, clarithromycin, and metronidazole) may improve perinatal outcome in preterm PROM.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Chorioamnionitis; Clarithromycin; Drug Therapy, Combination; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Metronidazole; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Retrospective Studies; Time Factors

To determine whether a new antibiotic regimen could reduce the frequency of intra-amniotic inflammation/infection in patients with preterm PROM.. This retrospective cohort study was conducted to evaluate the effect of antibiotics on the frequency of intra-amniotic inflammation/infection based on the results of follow-up transabdominal amniocenteses from 89 patients diagnosed with preterm PROM who underwent serial amniocenteses. From 1993-2003, ampicillin and/or cephalosporins or a combination was used ("regimen 1"). A new regimen (ceftriaxone, clarithromycin and metronidazole) was used from 2003-2012 ("regimen 2"). Amniotic fluid was cultured and matrix metalloproteinase-8 (MMP-8) concentrations were measured.. (1) The rates of intra-amniotic inflammation and intra-amniotic inflammation/infection in patients who received regimen 2 decreased during treatment from 68.8% to 52.1% and from 75% to 54.2%, respectively. In contrast, in patients who received regimen 1, the frequency of intra-amniotic inflammation and infection/inflammation increased during treatment (31.7% to 55% and 34.1% to 58.5%, respectively); and (2) intra-amniotic inflammation/infection was eradicated in 33.3% of patients who received regimen 2, but in none who received regimen 1.. The administration of ceftriaxone, clarithromycin and metronidazole was associated with a more successful eradication of intra-amniotic inflammation/infection and prevented secondary intra-amniotic inflammation/infection more frequently than an antibiotic regimen which included ampicillin and/or cephalosporins in patients with preterm PROM.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Ceftriaxone; Chorioamnionitis; Clarithromycin; Drug Therapy, Combination; Female; Fetal Membranes, Premature Rupture; Humans; Metronidazole; Pregnancy; Retrospective Studies; Young Adult

Topics: Adult; Anaphylaxis; Anti-Bacterial Agents; Ceftriaxone; Cesarean Section; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Obstetric Labor Complications; Pregnancy; Streptococcal Infections

Topics: Ceftriaxone; Cephalosporins; Drug Resistance, Multiple; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Male; Pregnancy; Salmonella typhi; Typhoid Fever

Ceftriaxone (CTRX), a new cephem antibiotic with high activity against Gram-positive and Gram-negative bacteria, was investigated pharmacokinetically in 30 mothers in the perinatal period. The obtained results are summarized below. 1. The maximum CTRX level in the maternal serum was 135 micrograms/ml between 20 and 25 minutes after an intravenous administration of 1 g of CTRX. 2. The transfer of CTRX into the umbilical cord serum and the amniotic fluid was very good. CTRX levels in these fluids were about 20% and 10% of the maternal serum level, respectively. 3. No side effect was observed in mothers or neonates. 4. CTRX is a useful antibiotic for perinatal infections.

Topics: Abortion, Induced; Amniotic Fluid; Ceftriaxone; Endometritis; Female; Fetal Blood; Fetal Membranes, Premature Rupture; Humans; Injections, Intravenous; Pregnancy; Puerperal Infection