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Meta-Analysis
. 2002;2002(3):CD003254.
doi: 10.1002/14651858.CD003254.

Antibiotic regimens for management of intraamniotic infection

L Hopkins  1 , F Smaill
Affiliations
Meta-Analysis

Antibiotic regimens for management of intraamniotic infection

L Hopkins et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: Intraamniotic infection is associated with maternal morbidity and neonatal sepsis, pneumonia and death. Although antibiotic treatment is accepted as the standard of care, few studies have been conducted to examine the effectiveness of different antibiotic regimens for this infection and whether to administer antibiotics intrapartum or postpartum.

Objectives: To study the effects of different maternal antibiotic regimens for intraamniotic infection on maternal and perinatal morbidity and mortality.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (May 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002).

Selection criteria: Trials where there was a randomized comparison of different antibiotic regimens to treat women with a diagnosis of intraamniotic infection were included. The primary outcome was perinatal morbidity.

Data collection and analysis: Data were extracted from each publication independently by the authors.

Main results: Two eligible trials (181 women) were included in this review. No trials were identified that compared antibiotic treatment with no treatment. Intrapartum treatment with antibiotics for intraamniotic infection was associated with a reduction in neonatal sepsis (relative risk (RR) 0.08; 95% confidence interval (CI) 0.00, 1.44) and pneumonia (RR 0.15; CI 0.01, 2.92) compared with treatment given immediately postpartum, but these results did not reach statistical significance (number of women studied = 45). There was no difference in the incidence of maternal bacteremia (RR 2.19; CI 0.25, 19.48). There was no difference in the outcomes of neonatal sepsis (RR 2.16; CI 0.20, 23.21) or neonatal death (RR 0.72; CI 0.12, 4.16) between a regimen with and without anaerobic activity (number of women studied = 133). There was a trend towards a decrease in the incidence of post-partum endometritis in women who received treatment with ampicillin, gentamicin and clindamycin compared with ampicillin and gentamicin alone, but this did not reach statistical significance (RR 0.54; CI 0.19, 1.49).

Reviewer's conclusions: The conclusions that can be drawn from this meta-analysis are limited due to the small number of studies. For none of the outcomes was a statistically significant difference seen between the different interventions. Current consensus is for the intrapartum administration of antibiotics when the diagnosis of intraamniotic infection is made; however, the results of this review neither support nor refute this although there was a trend towards improved neonatal outcomes when antibiotics were administered intrapartum. No recommendations can be made on the most appropriate antimicrobial regimen to choose to treat intraamniotic infection.

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Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Intrapartum versus postpartum ampicillin and gentamicin for intraamniotic infection, Outcome 1 Neonatal sepsis.
1.2
1.2. Analysis
Comparison 1 Intrapartum versus postpartum ampicillin and gentamicin for intraamniotic infection, Outcome 2 Neonatal pneumonia.
1.3
1.3. Analysis
Comparison 1 Intrapartum versus postpartum ampicillin and gentamicin for intraamniotic infection, Outcome 3 Neonatal death.
1.4
1.4. Analysis
Comparison 1 Intrapartum versus postpartum ampicillin and gentamicin for intraamniotic infection, Outcome 4 Maternal bacteremia.
2.1
2.1. Analysis
Comparison 2 Intrapartum ampicillin, gentamicin and clindamycin vs ampicillin and gentamicin for intraamniotic infection, Outcome 1 Neonatal sepsis.
2.2
2.2. Analysis
Comparison 2 Intrapartum ampicillin, gentamicin and clindamycin vs ampicillin and gentamicin for intraamniotic infection, Outcome 2 Neonatal death.
2.3
2.3. Analysis
Comparison 2 Intrapartum ampicillin, gentamicin and clindamycin vs ampicillin and gentamicin for intraamniotic infection, Outcome 3 Respiratory distress syndrome.
2.4
2.4. Analysis
Comparison 2 Intrapartum ampicillin, gentamicin and clindamycin vs ampicillin and gentamicin for intraamniotic infection, Outcome 4 Postpartum endometritis.
See this image and copyright information in PMC

References

References to studies included in this review

Gibbs 1988 {published data only}
    1. Gibbs R, Dinsmoor MD, Newton E, Ramamurthy R. A randomized trial of intrapartum versus immediate postpartum treatment of women with intra‐amniotic infection. Obstetrics and Gynecology 1988;72(6):823‐8. - PubMed
Maberry 1991 {published data only}
    1. Maberry M, Gilstrap L, Bawdon R, Little B, Dax J. Anaerobic coverage for intra‐amniotic infection: maternal and perinatal impact. American Journal of Perinatology 1991;8(5):338‐41. - PubMed
    1. Maberry M, Gilstrap L, Burris J, Bawdon R, Leveno K. A randomized comparative study of triple antibiotic therapy in the management of acute chorioamnionitis. Proceedings of 9th Annual Meeting of the Society of Perinatal Obstetricians; 1989; New Orleans, Louisiana, USA. 1989:465.

References to studies excluded from this review

Berry 1992 {published data only}
    1. Berry C, Hansen K, McCaul J. Single dose antibiotic therapy for clinical chorioamnionitis prior to vaginal delivery. American Journal of Obstetrics and Gynecology 1992;166:441.
Creatsas 1980 {published data only}
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References to studies awaiting assessment

Berry 1994 {published data only}
    1. Berry C, Hansen KA, McCaul JF. Abbreviated antibiotic therapy for clinical chorioamnionitis: a randomized trial. Journal of Maternal‐Fetal Medicine 1994;3(5):216‐8.
Budanov 2000 {published data only}
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Edwards 2004 {published data only}
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Locksmith 2003 {published data only}
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Locksmith 2005 {published data only}
    1. Locksmith GJ, Chin A, Vu T, Shattuck KE, Hankins GDV. High compared with standard gentamicin dosing for chorioamnionitis: a comparison of maternal and fetal serum drug levels. Obstetrics & Gynecology 2005;105:473‐9. - PubMed
Pullen 2007 {published data only}
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Additional references

Chapman 2014
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References to other published versions of this review

Smaill 1995
    1. Smaill F. Intrapartum vs postpartum treatment of amniotic infection [revised 04 October 1993]. In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C (eds.) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM]. The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.

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