Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Sep 7;2011(9):CD003767.
doi: 10.1002/14651858.CD003767.pub3.

Antibiotics for ureaplasma in the vagina in pregnancy

Camille H Raynes Greenow  1 , Christine L Roberts, Jane C Bell, Brian Peat, Gwendolyn L Gilbert, Sharon Parker
Affiliations

Antibiotics for ureaplasma in the vagina in pregnancy

Camille H Raynes Greenow et al. Cochrane Database Syst Rev. .

Abstract

Background: Preterm birth is a significant perinatal problem contributing to perinatal morbidity and mortality. Heavy vaginal ureaplasma colonisation is suspected of playing a role in preterm birth and preterm rupture of the membranes. Antibiotics are used to treat infections and have been used to treat pregnant women with preterm prelabour rupture of the membranes, resulting in some short-term improvements. However, the benefit of using antibiotics in early pregnancy to treat heavy vaginal colonisation is unclear.

Objectives: To assess whether antibiotic treatment of pregnant women with heavy vaginal ureaplasma colonisation reduces the incidence of preterm birth and other adverse pregnancy outcomes.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2011).

Selection criteria: Randomised controlled trials comparing any antibiotic regimen with placebo or no treatment in pregnant women with ureaplasma detected in the vagina.

Data collection and analysis: Three review authors independently assessed eligibility and trial quality and extracted data.

Main results: We included one trial, involving 1071 women. Of these, 644 women between 22 weeks and 32 weeks' gestation were randomly assigned to one of three groups of antibiotic treatment (n = 174 erythromycin estolate, n = 224 erythromycin stearate, and n = 246 clindamycin hydrochloride) or a placebo (n = 427). Preterm birth data was not reported in this trial. Incidence of low birthweight less than 2500 grams was only evaluated for erythromycin (combined, n = 398) compared to placebo (n = 427) and there was no statistically significant difference between the two groups (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.46 to 1.07). There were no statistically significant differences in side effects sufficient to stop treatment between either group (RR 1.25, 95% CI 0.85 to 1.85).

Authors' conclusions: There is insufficient evidence to assess whether pregnant women who have vaginal colonisation with ureaplasma should be treated with antibiotics to prevent preterm birth.Preterm birth is a significant perinatal problem. Upper genital tract infections, including ureaplasmas, are suspected of playing a role in preterm birth and preterm rupture of the membranes. Antibiotics are used to treat women with preterm prelabour rupture of the membranes; this may result in prolongation of pregnancy and lowers the risks of maternal and neonatal infection. However, antibiotics may be beneficial earlier in pregnancy to eradicate potentially causative agents.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Antibiotic versus placebo, Outcome 1 Low birthweight < 2500 g.
1.2
1.2. Analysis
Comparison 1 Antibiotic versus placebo, Outcome 2 Maternal side effects sufficient to stop or change treatment.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

McCormack 1987 {published data only}
    1. Kass EH, McCormack WM, Lin JS, Rosner B, Munoz A. Genital mycoplasmas as a cause of excess premature delivery. Transactions of the Association of American Physicians 1981;94:261‐6. - PubMed
    1. McCormack WM, Rosner B, Lee YH, Munoz A, Charles D, Kass EH. Effect of birth weight of erythromycin treatment of pregnant women. Obstetrics & Gynecology 1987;69:202‐7. - PubMed

References to studies excluded from this review

Eschenbach 1991 {published data only (unpublished sought but not used)}
    1. Eschenbach DA, Nugent RP, Rao V, Cotch MF, Gibbs RS, Lipscomb KA, et al. A randomized placebo‐controlled trial of erythromycin for the treatment of ureaplasma urealyticum to prevent premature delivery. American Journal of Obstetrics and Gynecology 1991;164:734‐42. - PubMed
    1. Nugent RP. Ureaplasma urealyticum and pregnancy outcome: results of an observational study and clinical trial. American Journal of Epidemiology 1988;128:929‐30.
Hauth 1995 {published data only}
    1. Hauth JC, Goldenberg RL, Andrews WW, DuBard B, Copper RL. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. New England Journal of Medicine 1995;333(26):1732‐6. - PubMed
Hauth 2001 {published data only}
    1. Hauth JC, Cliver S, Hodgkins P, Andrews WW, Schwebke JR, Hook EW, et al. Mid‐trimester metronidazole and azithromycin did not prevent preterm birth in women at increased risk: a double‐blind trial. American Journal of Obstetrics and Gyncology 2001;185(Suppl 6):S86.
Kass 1986 {published data only}
    1. Kass EH, Lin JS, McCormack WM. Low birth weight and maternal colonization with genital mycoplasmas. Pediatric Infectious Diseases 1986;5(6):S279‐S281. - PubMed
McCormack 1977 {published data only}
    1. McCormack WM, George H, Donner A, Kodgis LF, Alpert S, Lowe EW, et al. Hepatotoxicity of erythromycin estolate during pregnancy. Antimicrobial Agents and Chemotherapy 1977;12:630‐5. - PMC - PubMed
McGregor 1988 {published data only}
    1. McGregor JA, French JI, Richter R, Vuchetich M, Bachus V, Seo K, et al. Cervicovaginal microflora and pregnancy outcome: results of a double‐blind, placebo‐controlled trial of erythromycin treatment. American Journal of Obstetrics and Gynecology 1990;163:1580‐91. - PubMed
Ogasawara 1997 {published data only}
    1. Ogasawara KK, Goodwin TM. The efficacy of prophylactic erythromycin in preventing vertical transmission of ureaplasma urealyticum. American Journal Perinatology 1997;14(4):233‐7. - PubMed
Ogasawara 1999 {published data only}
    1. Ogasawara KK, Goodwin TM. Efficacy of azithromycin in reducing lower genital ureaplasma urealyticum colonization in women at risk of preterm delivery. Journal of Maternal and Fetal Medicine 1999;8:12‐6. - PubMed
Paul 1998 {published data only}
    1. Paul VK, Singh M, Buckshee K. Erythromycin treatment of pregnant women to reduce the incidence of low birth weight and preterm deliveries. International Journal of Gynecology & Obstetrics 1998;62:87‐8. - PubMed
Winkler 1988 {published data only}
    1. Winkler M, Baumann L, Ruckhaberle KE, Schiller EM. Erthromycin for subclinical intrauterine infections in threatened preterm delivery ‐ a preliminary report. Journal of Perinatal Medicine 1988;16(3):253‐6. - PubMed
Ye 2001 {published data only}
    1. Ye Y, Tu S, Li H. Clinic intervention study on urogenital mycoplasma infection of pregnant women. Chung‐Hua Liu Hsing Ping Hsueh Tsa Chih: Chinese Journal of Epidemiology 2001;22(4):293‐5. - PubMed

Additional references

Abele‐Horn 2000
    1. Abele‐Horn M, Scholz M, Wolff C, Kolben M. High‐density vaginal ureaplasma urealyticum colonization as a risk factor for chorioamnionitis and preterm delivery. Acta Obstetricia et Gynecologica Scandinavica 2000;79(11):973‐8. - PubMed
Cassell 1988
    1. Cassell GH, Waites KB, Crouse DT, Rudd PT, Canupp KC, Stagno S, et al. Association of ureaplasma urealyticum infection of the lower respiratory tract with chronic lung disease and death in very‐low‐birth‐weight infants. Lancet 1988;2(8605):240‐5. - PubMed
Cassell 1993a
    1. Cassell GH, Andrews W, Hauth J, Cutter G, Hamrick W, Baldus K, et al. Isolation of microorganisms from the chorioamnion is twice that from amniotic fluid at cesarean delivery in women with intact membranes [abstract]. American Journal of Obstetrics and Gynecology 1993;168:424.
Cassell 1993b
    1. Cassell GH, Waites KB, Watson HL, Crouse DT, Harasawa R. Ureaplasma urealyticum intrauterine infection: role in prematurity and disease in newborns. Clinical Microbiology Reviews 1993;6(1):69‐87. - PMC - PubMed
Gilbert 1995
    1. Gilbert GL. Ureaplasmas and human disease. Recent Advances in Microbiology. Melbourne: Australian Society for Microbiology, 1995.
Goldenberg 2000
    1. Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. New England Journal of Medicine 2000;342(20):1500‐7. - PubMed
Gravatt 2010
    1. Gravett M, Rubens C, Nunes T, the GAPPS Review Group. Global report on preterm birth and stillbirth (2 of 7): discovery science. BMC Pregnancy and Childbirth 2010;10 Suppl 1:S2. - PMC - PubMed
Hall 1997
    1. Hall M, Danielian P, Lamont RF. The importance of preterm birth. In: Elder MG, Romero R, Lamont RF editor(s). Preterm Labour. Edinburgh: Churchill Livingstone, 1997:1‐28.
Hannaford 1999
    1. Hannaford K, Todd DA, Jeffery H, John E, Blyth K, Gilbert GL. Role of ureaplasma urealyticum in lung disease of prematurity. [erratum appears in Archives of Disease in Childhood, Fetal and Neonatal Edition 2000 Jan;82(1):F78]. Archives of Disease in Childhood, Fetal and Neonatal Edition 1999;81(3):F162‐F167. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hillier 1988
    1. Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschenbach DA. A case‐control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. New England Journal of Medicine 1988;319(15):972‐8. - PubMed
Kenyon 2001
    1. Kenyon SL, Taylor DJ, Tarnow‐Mordi W. Broad‐spectrum antibiotics for spontaneous preterm labour: the ORACLE II randomised trial. Lancet 2001;357:981‐90. - PubMed
Kenyon 2010
    1. Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database of Systematic Reviews 2010, Issue Issue 8. [DOI: 10.1002/14651858.CD001058.pub2] - DOI - PubMed
King 2002
    1. King J, Flenady V, Murray L. Prophylactic antibiotics for inhibiting preterm labour with intact membranes. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858.CD000246] - DOI - PubMed
Kramer 2000
    1. Kramer MS, Demissie K, Yang H, Platt RW, Sauve R, Liston R. The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. JAMA 2000;284(7):843‐9. - PubMed
Lawn 2010
    1. Lawn J, Gravett M, Nunes T, Rubens C, Stanton C, the GAPPS Review Group. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy and Childbirth 2010;10 Suppl 1:S1. - PMC - PubMed
McDonald 1992
    1. McDonald HM, O'Loughlin JA, Jolley P, Vigneswaran R, McDonald PJ. Prenatal microbiological risk factors associated with preterm birth. British Journal of Obstetrics and Gynaecology 1992;99(3):190‐6. - PubMed
McDonald 1997
    1. McDonald H. The role of vaginal flora in normal pregnancy and preterm labor. In: Elder MG, Romero R, Lamont RF editor(s). Preterm Labor. 1st Edition. New York: Churchill Livingstone, 1997:65‐83.
McDonald 2007
    1. McDonald HM, Brocklehurst P, Gordon A. Antibiotics for treating bacterial vaginosis in pregnancy. Cochrane Database of Systematic Reviews 2007, Issue 1. [DOI: 10.1002/14651858.CD000262.pub3] - DOI - PMC - PubMed
McGregor 1990
    1. McGregor JA, French JI, Richter R, Vuchetich M, Bachus V, Seo K, et al. Cervicovaginal microflora and pregnancy outcome: results of a double‐blind, placebo‐controlled trial of erythromycin treatment. American Journal of Obstetrics and Gynecology 1990;163(5 Pt 1):1580‐91. - PubMed
RevMan 2000 [Computer program]
    1. The Cochrane Collaboration. Review Manager (RevMan). Version 4.1 for Windows. Oxford, England: The Cochrane Collaboration, 2000.
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Roberts 2000
    1. Roberts JM. Recent advances: obstetrics. BMJ 2000;321(7252):33‐5. - PMC - PubMed
Smaill 1995
    1. Smaill F. Erythromycin for treatment of ureaplasma during pregnancy. [revised Oct 4 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 disc and CDROM). The Cochrane Collaboration; Issue 2, Oxford: Update Software; 1995.
Wood 2000
    1. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. New England Journal of Medicine 2000;343(6):378‐84. - PubMed

References to other published versions of this review

Raynes‐Greenow 2004
    1. Raynes‐Greenow CH, Roberts CL, Bell JC, Peat B, Gilbert GL. Antibiotics for ureaplasma in the vagina in pregnancy. Cochrane Database of Systematic Reviews 2004, Issue 1. [DOI: 10.1002/14651858.CD003767.pub2] - DOI - PubMed

Publication types

MeSH terms