Do We Need Antibiotics for Premature Rupture of Membranes?

The Lancet, Volume 372, Issue 9646, Pages 1310 – 1318, 11 October 2008

Editors’ note: In 2001, the ORACLE I trial showed that in women with premature rupture of the fetal membranes, but no overt sign of infection, erythromycin and co-amoxiclav prolonged pregnancy and erythromycin also improved neonatal outcomes. The ORACLE Children I study followed these children to 7 years of age to assess functionality and educational outcomes. There were no differences in childrens’ functionality between women receiving erythromycin, co-amoxiclav, both antibiotics, or neither.
Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes:
7-year follow-up of the ORACLE I trial

S Kenyon MA a Corresponding AuthorEmail Address, K Pike MSc a, Prof DR Jones PhD b, Prof P Brocklehurst FRCOG c, Prof N Marlow FMedSci d, A Salt FRCPCH e, Prof DJ Taylor FRCOG a
The ORACLE I trial compared the use of erythromycin and/or amoxicillin—clavulanate (co-amoxiclav) with that of placebo for women with preterm rupture of the membranes without overt signs of clinical infection, by use of a factorial randomised design. The aim of the present study—the ORACLE Children Study I—was to determine the long-term effects on children of these interventions.

We assessed children at age 7 years born to the 4148 women who had completed the ORACLE I trial and who were eligible for follow-up with a structured parental questionnaire to assess the child’s health status. Functional impairment was defined as the presence of any level of functional impairment (severe, moderate, or mild) derived from the mark III Multi-Attribute Health Status classification system. Educational outcomes were assessed with national curriculum test results for children resident in England.

Outcome was determined for 3298 (75%) eligible children. There was no difference in the proportion of children with any functional impairment after prescription of erythromycin, with or without co-amoxiclav, compared with those born to mothers who received no erythromycin (594 [38·3%] of 1551 children vs 655 [40·4%] of 1620; odds ratio 0·91, 95% CI 0·79—1·05) or after prescription of co-amoxiclav, with or without erythromycin, compared with those born to mothers who received no co-amoxiclav (645 [40·6%] of 1587 vs 604 [38·1%] of 1584; 1·11, 0·96—1·28). Neither antibiotic had a significant effect on the overall level of behavioural difficulties experienced, on specific medical conditions, or on the proportions of children achieving each level in reading, writing, or mathematics at key stage one.

The prescription of antibiotics for women with preterm rupture of the membranes seems to have little effect on the health of children at 7 years of age.

UK Medical Research Council.

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