814 USE OF PROPHYLACTIC ANTIBIOTICS AFTER PROLONGED RUPTURE OF MEMBRANES

Abstract

We studied the effect of antibiotic prophylaxis in neonates born after PROM. 95 infants ≥ 35 weeks gestation, with PROM > 24 hrs., were randomly assigned to 2 groups. Group A received Penicillin and Gentamicin for 3 days and group B did not receive antibiotics. Birth weight, gestational age, and Apgar score were similar in both groups. Cultures were taken in the first 4 hours of life from blood, CSF, urine, gastric content, ears and axilla. 92% of all infants had a positive surface culture. Three of 95 infants had a positive blood culture; 2 in group A and 1 in group B. One infant in group A had Group B β hemolytic Streptococcus (GB β HS) septicemia with uneventful recovery and another had asymptomatic bacteremia with α hemolytic Streptococcus. In group B, one infant had asymptomatic bacteremia with GBβ HS. Rectal swab cultures done on the 3rd day of life, demonstrated 22% colonization with antibiotic-resistant organisms in group A compared to 5.4% in group B. The duration of hospitalization in Group A (6.3 days) was longer than group B (4.8). The risk of systemic infection in infants born after PROM appears low and cannot be determined by surface cultures. Routine use of antibiotics in infants born after PROM increases the duration of hospital stay and increases the incidence of antibiotic resistant intestinal flora. Because of this and the low incidence of systemic infection, prophylactic use of antibiotics does not seem justified in cases of asymptomatic PROM.