690: Equivalence of erythromycin and azithromycin for treatment of PPROM

Abstract

for treatment of PPROM Shari Gelber, Elyssa Brent, Aneesha Varrey, Bella Fridman, Katherine Sapra, William Frayer Weill Cornell Medical College, Obstetrics and Gynecology, New York, NY, Weill Cornell Medical College, Pediatrics, New York, NY, Columbia University, Pediatrics, New York, NY OBJECTIVE: A regimen of ampicillin and erythromycin (ERY) improves outcomes in patients with Preterm Premature Rupture of Membranes (PPROM). NationalshortagesofERY,patientsensitivitytoERY,andsimilar mechanism of action have encouraged providers to substitute Azithromycin (AZ). Some expert guidelines now recommend use of AZ, despite limited knowledge of efficacy in this setting. We sought to determine if treatment with AZ is equivalent to treatment with ERY for PPROM. STUDY DESIGN: Retrospective chart review of patients with PPROM admitted to labor and delivery at an academic center who received either ERY or AZ between January 2009 and March 2012. Inclusion criteria were gestational age 24-34 wk, planned expectant management and receipt of 1 dose of ERY or AZ. Exclusion criteria were delivery prior to receipt of antibiotics or receipt of both ERY and AZ. At our institution, decision to use AZ is determined by unavailability or patient intolerance of ERY and is not practitioner dependent. 2 and Fisher tests for categorical variables and Mann-Whitney test for continuous variables were done. Primary composite outcome was infant death, RDS, grade 3-4 IVH, NEC or sepsis 72 h of life. RESULTS: 103 patients met inclusion criteria; 7 were excluded for receiving both ERY/AZ. Data from 96 patients were analyzed. 67 patients received ERY and 29 patients received AZ. There were no statistically significant differences in age, ethnicity, BMI, GA at PPROM (ERY: 30.42 vs AZ: 30.85 p 0.53), history of preterm deliveries, parity, smoking, GBS status, or receipt of ampicillin or steroids between groups. There were no statistically significant differences in maternal or fetal outcomes between the groups(Table 1). There was no difference in latency (ERY: 65.6h vs AZ 61.7h). CONCLUSION: AZ provides the same benefit as ERY in the setting of PPROM. Although there is no significant difference in outcomes between groups, the trend toward improvement in several outcomes indicates studies are warranted to see if AZ is the preferred agent for PPROM.