Antibiotics for prelabour rupture of membranes at or near term

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Abstract
Prelabour rupture of the membranes at or near term (term PROM) increases the risk of infection for the woman and her baby. The routine use of antibiotics for women at the time of term PROM may reduce this risk. However, due to increasing problems with bacterial resistance and the risk of maternal anaphylaxis with antibiotic use, it is important to assess the evidence addressing risks and benefits in order to ensure judicious use of antibiotics. This review was undertaken to assess the balance of risks and benefits to the mother and infant of antibiotic prophylaxis for prelabour rupture of the membranes at or near term. To assess the effects of antibiotics administered prophylactically to women with prelabour rupture of the membranes at 36 weeks or beyond, on maternal, fetal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (September 2008). All randomised trials which compared outcomes for women and infants when antibiotics were administered prophylactically for prelabour rupture of the membranes at or near term, with outcomes for controls (placebo or no treatment). Two authors independently extracted the data and assessed trial quality. Additional data were received from the investigators of included trials. The results of two trials, involving a total of 838 women, are included in this review. The use of antibiotics resulted in a statistically significant reduction in maternal infectious morbidity (chorioamnionitis or endometritis): (risk ratio (RR) 0.43; 95% confidence interval (CI) 0.23 to 0.82); (risk difference (RD) -4%; 95% CI -7% to -1%); (number needed to treat (NNT) 25; 95% CI 14 to100). No statistically significant differences were shown for outcomes of neonatal morbidity. However, one study of 105 women showed a reduction in neonatal length of stay (mean difference -0.90; 95% CI -1.34 to -0.46). No clear practice recommendations can be drawn from the results of this review on this clinically important question, related to a paucity of reliable data. Further well-designed randomised controlled trials are needed to assess the effects of routine use of maternal antibiotics for women with prelabour rupture of the membranes at or near term. 用於早期破水或鄰近產期破水的抗生素 早期破水或鄰近產期之足月破水(term PROM)，會增加母親和胎兒的感染風險。對鄰近產期之足月婦女例行性使用抗生素可以減少此風險。不過，因為有增加細菌抗藥性和母親對於抗生素過敏的風險，評估相關利益和風險的證據就很重要，以確保明智而審慎的使用抗生素。進行此回顧以瞭解用於早期破水或臨產期破水之預防性抗生素，對於母親和嬰兒的利益與風險。 評估在懷孕36週之後給予孕婦之預防性抗生素，對於孕婦本身、胎兒和新生兒結果之效果。 我們搜尋Cochrane Pregnancy和Childbirth Group之控制試驗特定登記資料庫(2005年9月30日)、Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001)、 EDLINE (1965年2001年)。其他來源包括聯絡公認的專家和交叉比較相關資料。 比較用於早期破水或臨產期破水的預防性抗生素和控制組(安慰劑或無治療)，對於母親和嬰兒之結果的所有隨機試驗。 由2位作者獨立評估試驗品質與摘錄資料，之後比較和分析差異。從研究者和納入的試驗獲得額外的資料。使用固定效果模式進行後設分析，以相對危險性(RR)、危險差(RD)、需要治療的病人數目(NNT)等代表各類資料的結果，以平均差(MD)代表測量之變項的連續範圍。所有結果都以95% 信心區間(CI)呈現。 此次回顧納入2篇試驗、838名婦女。使用抗生素對於減少母親感染(絨毛膜羊膜炎或子宮內膜炎)發病率有統計上的顯著意義: RR 0.43 (95% CI為0.23, 0.82), RD −4% (95% CI為 −7%, −1%), NNT 25 (95% CI為14 – 100)。對於新生兒發病率的結果並無統計上的顯著差異。 因為可信賴的資料有限，無法就此次回顧之結果對此一重要臨床問題作出具體的實務建議。後續需要設計良好的隨機控制試驗，來評估常規使用抗生素於早產破水或臨產期破水婦女的效果。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 當臨近產期之足月破水時使用抗生素，可降低孕婦感染率，但是需要更多研究瞭解對於胎兒的安全性和影響。有時候，羊膜(包覆胎兒週遭的羊水袋子)在足月時破裂，但是產程未開始，這稱為足月破水。一旦羊膜破裂，即會有子宮內感染之風險。通常會給予抗生素以預防這些婦女足月破水之後的感染，但是也可能有副作用。此次回顧發現，足月破水時，常規使用抗生素可減少孕婦之感染風險，但是其他結果(包括嬰兒的感染和併發症)的證據不夠強烈。

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