Prophylactic antibiotics for inhibiting preterm labour with intact membranes

Abstract

The contribution of subclinical genital tract infection to the aetiology of preterm birth is gaining increasing recognition, but the role of prophylactic antibiotic treatment in the management of preterm labour is uncertain. Since rupture of the membranes is an important factor in the progression of preterm labour, it is important to see if the routine administration of antibiotics confers any benefit, prior to membrane rupture. To assess the effects of prophylactic antibiotics administered to women in preterm labour with intact membranes, on maternal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2002), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002), MEDLINE (1965 to May 2002). Other sources included contacting recognised experts and cross referencing relevant material. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 30 April 2010 and added the results to the awaiting classification section of the review. Randomised trials which compared antibiotic treatment with placebo or no treatment for women in preterm labour (between 20 and 36 weeks' gestation) with intact membranes. Standard methods of the Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used. Evaluation of methodological quality and trial data extraction were undertaken independently by the authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. This review has been updated (2002) to include data from the 'ORACLE II 2001' trial (six times larger than the previous 10 trials combined), which now dominates the results of this review. Meta-analysis of the 11 included trials (7428 women enrolled) shows a reduction in maternal infection with the use of prophylactic antibiotics (relative risk 0.74, 95% confidence interval 0.64 to 0.87) but fails to demonstrate a benefit or harm for any of the prespecified neonatal outcomes. This review fails to demonstrate a clear overall benefit from prophylactic antibiotic treatment for preterm labour with intact membranes on neonatal outcomes and raises concerns about increased neonatal mortality for those who received antibiotics. This treatment cannot therefore be currently recommended for routine practice. Further research may be justified (when sensitive markers for subclinical infection become available) in order to determine if there is a subgroup of women who could experience benefit from antibiotic treatment for preterm labour prior to membrane rupture, and to identify which antibiotic or combination of antibiotics is most effective. [Note: The 17 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.] 在維持胎膜完整的前提下，用預防性抗生素來抑制早產 無臨床症狀的生殖道感染為導致早產的其中一個病因，已經越來越被肯定，但是預防性抗生素在處理早產的角色，還是不確定的。破水是早產持續進行中的一項重要的因素，所以在破水之前，例行性地給予抗生素是否可以帶來任何助益，就顯得很重要了 在維持胎膜完整的前提下，評估對於提早產痛之婦女給予預防性抗生素時，對母體與新生兒的預後之影響 我們搜尋了the Cochrane Pregnancy and Childbirth Group's specialised register of controlled trials(2002年五月)、the Cochrane Controlled Trials Register(The Cochrane Library，Issue 1，2002年)、MEDLINE(1965年到2002年五月)。其他的來源包括了向我們知道的專家聯繫，以及交叉文獻的相關資料 在維持胎膜完整的前提下，針對發生提早產痛的婦女(介於20到36周的孕期之間)，這些隨機的試驗將抗生素療法與安慰劑或是不採取治療進行了比較 當中使用了the Cochrane Collaboration與the Cochrane Pregnancy and Childbirth Group的標準方法。這些作者獨立進行了方法品質的評估，並擷取出試驗的資料。這些結果是以相對風險(RR)來表示類別資料，以加權平均差(WMD)來表示連續資料 本篇回顧已經在2002年更新過，有涵蓋「ORACLE II 2001」試驗(比之前的10組試驗加起來還要大上6倍)中的資料，而這些資料目前已可主導本篇回顧的結果。包含了11組試驗(共納入了7428名婦女)的統合分析顯示，使用預防性抗生素減低母親感染的比例(相對風險0.74, 95% 信賴區間0.64 to 0.87)，但是對於任何一種的新生兒預後，卻沒有提供優點或是危險 本篇回顧顯示，在維持胎膜完整的前提之下，針對提早產痛之孕婦使用預防性抗生素，並不能改善新生兒的預後，並且可能會有提高新生兒死亡率的顧慮。因此，目前還不能將這樣的療法推薦在例行性的實務中使用。進一步的研究可能要再調整(當有靈敏的指標可以來偵測無臨床症狀的感染時)，以用來決定是否存在有某種在破水前有提早產痛之婦女的次群組可以從抗生素療法中得到好處，並確認那一種抗生素或是那種抗生素的組合最有效 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌...