Reply: Antibiotic therapy in preterm premature rupture of the membranes.

We would like to express our gratitude to Yang and colleagues for their interest in our recently published study, “A randomized clinical trial of antibiotics treatment duration in preterm premature rupture of membranes: 7 days vs until delivery.” We agree that it would have been ideal to enroll patients on the 7th day from rupture of membranes (ROM). However, it is well known that more than 50% of patients with preterm premature ROM (PPROM) deliver within 7 days, 1 Prelabor rupture of membranes: ACOG Practice Bulletin, Number 217. Obstet Gynecol. 2020; 135: e80-e97 Crossref PubMed Scopus (113) Google Scholar and this was reflected in our study population. An ideal design may have resulted in a lower number of study participants, thus reducing the study's power or causing selection bias. Because of the challenges of conducting randomized clinical trials involving pregnant women, we decided to randomize patients on admission and compare the proportion of women who delivered within 7 days, as demonstrated in Table 1 of the original article. This type of randomization was also used in 2 trials of patients with PPROM published in the American Journal of Obstetrics & Gynecology: the study by Lewis et al, 2 Lewis DF Adair CD Robichaux AG et al. Antibiotic therapy in preterm premature rupture of membranes: are seven days necessary? A preliminary, randomized clinical trial. Am J Obstet Gynecol. 2003; 188: 1413-1416 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar which compared 3 or 7 days of ampicillin-sulbactam regimen, and the study by Segel et al, 3 Segel SY Miles AM Clothier B Parry S Macones GA. Duration of antibiotic therapy after preterm premature rupture of fetal membranes. Am J Obstet Gynecol. 2003; 189: 799-802 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar which compared 3 or 7 days of ampicillin. In our study, both groups had a similar rate of preterm delivery within 7 days from ROM (46.0% in the 7-day group and 47.5% in the until-delivery group) and an interval from ROM to delivery of 8 days in both groups, similar to the finding of Lewis's and Segel's studies. Antibiotic therapy in preterm premature rupture of the membranesAmerican Journal of Obstetrics & Gynecology MFMVol. 5Issue 6PreviewPreterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and is one of the leading causes of preterm birth.1 Preterm birth because of PPROM remains one of the greatest challenges in modern obstetrics. Administering antibiotic treatment in women with PPROM is suggested by several guidelines with slight differences in the proposed regimen,2,3 based on the theory that intrauterine infection can be both a cause and a consequence of PPROM, exposing the mother, the fetus, and subsequently the neonate to increased perinatal morbidity. Full-Text PDF