Antibiotics for treatment of preterm labor: review and meta-analysis

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Abstract
Objective: Inflammatory processes and infection contribute to the risk of preterm birth. We sought to review the literature on antibiotics for the treatment of preterm labor (PTL) and to do a meta-analysis of results from randomized trials. Methods: We worked as part of the AHCPR Evidence Report on the Management of Preterm Labor. With ACOG and an advisory group, we developed search criteria. We did an exhaustive search, including the gray literature, for articles in English, French, or German, from 1966 to 1998. We searched for randomized trials and observational studies on antibiotics for preterm birth among women with PTL. We found 107 articles; 15 had 40 or more subjects with outcome measurement of gestational age at birth and without rupture of membranes at enrollment. Abstractors were masked to authorship and journal. Elements abstracted included definition of PTL, study design, treatment regimen, population characteristics, masking, randomization, and analytic approach. Outcomes included delay in delivery, gestational age at birth, and proportion of births by prematurity (eg, less than 37 weeks of gestation and more than 30 weeks of gestation). Results: We will summarize the literature on antibiotics for treatment of PTL and reflect on the divergent regimens and findings in major studies. We will report the results of meta-analyses, including 13 randomized trials that examine antibiotic treatment and prolongation of pregnancy in days, gestational age at birth, and birth weight. Conclusion: We will present the conclusions of the team.

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