Changes in vaginalUreaplasmaandLactobacillusdue to antibiotic regimen for premature rupture of membranes

Abstract

AbstractPreterm premature rupture of membranes (PPROM) is associated with preterm delivery and neonatal complications. PPROM is often complicated by intra-amniotic inflammation and/or microbial invasion of the amniotic cavity withUreaplasmaorMycoplasma. Various prophylactic antibiotic therapies have been proposed to prolong latency between PPROM and delivery, reduce the risk of clinical chorioamnionitis, and improve neonatal complications. However, information on the potential of azithromycin administration to reduce the microbial load of vaginalUreaplasmaandMycoplasmaremains lacking. This prospective cohort study included singleton pregnancies managed with prophylactic antibiotics for PPROM at less than 36 weeks of gestation. All patients received the standard antibiotic regimen for PPROM, which consisted of a single oral azithromycin and intravenous ampicillin every for 2 days followed by 5 days of oral amoxicillin. Vaginal swabs samples were collected when PPROM was confirmed and after the antibiotic regimen administration. The main outcome measures were to investigate the changes in vaginalUreaplasma, Mycoplasma,andLactobacillus spp.due to the antibiotic regimen. In addition, the association between the presence and changes in vaginalUreaplasmaandMycoplasma, pregnancy outcomes, and neonatal complications were examined. Out of 82 eligible PPROM, 51 had positive vaginalUreaplasma. Thirty-six patients (52.2%) completed the antibiotic regimen. Among those with positive vaginalUreaplasmawho completed the antibiotic regimen, 75% experienced an increase in vaginalUreaplasmalevels. For those who delivered before completing all antibiotic doses, 40% had increased vaginalUreaplasmalevels. Furthermore, the antibiotic regimen resulted in decreasedLactobacillus spp.in almost all cases. However, vaginalUreaplasmachanges were not found to be associated with neonatal sepsis or bronchopulmonary dysplasia. This suggests thatUreaplasmabecame resistant to azithromycin. Future studies are needed to revalidate current antibiotic therapy for PPROM.