Use Of Antibiotics In Women Research Articles

COVID-19 Vaccination Status and Rational Use of Antibiotics in Women: A Prospective Cross-Sectional Study during the COVID-19 Pandemic in India

COVID-19 Vaccination Status and Rational Use of Antibiotics in Women: A Prospective Cross-Sectional Study during the COVID-19 Pandemic in India

Use of antibiotics in women undergoing correction of an obstetric anal sphincter injury: Results from a national Israeli survey.

Obstetric anal sphincter injures (OASIS) have long-term implications on women's health. Administration of antibiotic prophylaxis and treatment following OASIS repair is controversial. We conducted a national survey to provide data about practice routines regarding antibiotic prophylaxis and treatment following OASIS repair in Israeli labor and delivery units. A national survey was performed among obstetricians and gynecologists from 24 university-affiliated delivery centers within the jurisdiction of the Israeli Ministry of Health during 2020. Representatives from each center completed the "Google form" electronic survey. For each questionnaire item, the most common answer was chosen to represent the center's answer. The number of physicians who responded per center varied from 1 to 14 (median, 3.5). Preoperative and postoperative antibiotic treatment was given in 75% and 92% of the centers, respectively. While most centers (58.3%) recommend pelvic floor physical therapy on release, recommendations about functional radiologic tests vary. In all centers, there is a designated clinic for postpartum follow-up of OASIS. Most centers (83%) allow trial of vaginal delivery in the subsequent pregnancy, on an individual basis. Heterogeneity exists in managing OASIS in Israel, particularly regarding administration of antibiotics. Further studies are needed to examine the consequences of different management protocols.

Perioperative antibiotic prophylaxis for abdominal delivery at the regional perinatal center

Aim. To conduct a comparative pharmacoepidemiological study and assess the rational use of antibiotics in women undergoing caesarean section.
 Methods. A retrospective analysis of 1,025 birth histories of women after planned and emergency cesarean section was carried out with a detailed assessment of the use of antibiotics in 20072009 (523) and 20162017 (502) with an interval of 10 years for which new clinical guidelines, principles of rational pharmacotherapy and evidence-based medicine were introduced. The time of administration of the first dose, duration of administration, consumption of antibiotics were assessed. The significance of differences in relative indicators was assessed according to Pearson (2).
 Results. Antibiotics were prescribed to women with planned and emergency caesarean section in 100% of cases in the first period of the study (20072009) and prescribed in 98% of women with planned caesarean section and 96% with emergency caesarean section in the second period (20162017). In the first period, the first dose of antibiotic was administered: in 110 (44%) cases during surgery and 139 (56%) cases after surgery in planned caesarean section; in 139 (51%) cases during surgery and 135 (49%) cases after surgery in emergency caesarean section. In the second period, antibiotics were administered 3060 minutes before the operation in 263 (96%) cases in the planned caesarean section and 218 (95%) cases in the emergency; postoperative antibiotics were administered in 7 (2%) women in the planned caesarean section and 2 (1%) women in the emergency (p 0.05). Greater than 56 days of antibiotics were used: in 166 (67%) women in the planned operation and 166 (61%) in the emergency for the first period; in 43 (16%) women with the planned operation, and 38 (17%, p 0.05) women with an emergency for the second period. In the first period, 13 antibiotics from 8 pharmacotherapeutic groups were used and in the second period, 7 out of 5 were used.
 Conclusion. From 2007 to 2017, the use of antibiotics has become to comply with the implemented clinical guidelines for abdominal delivery: the duration of antibiotic use has decreased, the time of administration of the first dose and the range of antibiotics used changed.

Peningkatan Penggunaan Antibiotik Bijak pada Kelompok Pemberdayaan Wanita di Daerah Perkotaan di Kabupaten Banyumas Melalui Tindakan Intervensi KAP (Knowledge, Attitude, Practice)

INCREASING OF THE USE OF WISE ANTIBIOTIC IN WOMAN'S EMPOWERMENT GROUP IN THE URBAN AREA OF BANYUMAS REGENCY BY PROVIDING INTERVENTION OF KAP (KNOWLEDGE, ATTITUDE, PRACTICE). Unwise use of antibiotic behavior in the community contributes significantly to the increase in the incidence of antibiotic resistance. Antibiotic resistance has become a major health problem throughout the world that must receive attention both in hospitals and in the community. The purpose of this community service is as an effort to increase the use of wise antibiotics in women's empowerment groups in urban areas in Banyumas Regency by intervening Knowledge, Attitude, Practice (KAP). The target audience was an urban community group in Banyumas regency, namely all members of the Rambutan women's empowerment group located at Jl. Kalijaga, Berkoh, Purwokerto. The activities carried out for KAP intervention were knowledge transfer, and educational video included antibiotics, the wise use of antibiotics, and the dangers of antibiotic resistance. The results of the KAP intervention were measured by questionnaires containing statements from aspects of Knowledge, attitude, practice before and after KAP intervention activities. Each statement in the questionnaire was assessed with a Likert scale and tested for its validity and reliability. Data were analyzed descriptively while testing the results of questionnaires I and II were carried out by paired T-Tests. Data that can be analyzed are 39 respondents. The results of the questionnaire analysis showed an increase in KAP about antibiotic use before and after KAP interventions in women's empowerment groups in urban areas of Banyumas Regency. The article concluded that KAP intervention actions could achieve an increase in the use of wise antibiotics in women's empowerment groups in urban areas in Banyumas Regency.

Antibiotic Regimen and Induction of Labour Protocol Used in Spontaneous Rupture of Membrane-A Clinical Audit Conducted at a Rural Tertiary Care Hospital In Andhra Pradesh

Background: Prelabour rupture of the membranes (PROM) at term or pre-term increases the risk of infection for the woman and her baby. The routine use of antibiotics for women with PROM or PPROM may reduce this risk. However, due to increasing problems with bacterial resistance and it is important to ensure judicious use of antibiotics. Many studies have reported a wide matrix of variation in the management protocol of spontaneous rupture of membrane before the onset of labour at term or pre-term. Hence, we undertook an audit to assess the need for antibiotic prophylaxis and induction of labour in women with PROM or PPROM. Objective: In the paucity of a uniform protocol in the institution, this study aimed to fix a common antibiotic regimen and induction of labour protocol in all cases of PROM and PPROM. Methods: A retrospective and prospective clinical audit was conducted in the department of OBG, PESIMR, Kuppam, for the accrual period of October 2014–October 2015. A retrospective audit for a period of 6 months of the different management protocols of PROM & PPROM cases was carried out to know the prevailing practices of all recruited patients in our hospital across all the three units. Data was collected in a systematic manner using a formatted proforma from the medical records. Following introduction of a uniform protocol, a prospective study was conducted for 6 months. Results: It was noted that in the prospective study the need for antibiotics was reduced to 84.61% as compared to 93.84% in the retrospective group. 69.23% of women required induction in the retrospective group, whereas only 25.64% required induction in the prospective group. The difference was statistically significant. There was not much difference in the caesarean section rates, maternal & neonatal morbidity prior to and following introduction of a uniform protocol (46.15% in the retrospective group to 48.71% in the prospective group). Conclusions: This study helped us introduce a uniform protocol in the department. It reduced the need for induction and antibiotic usage. There was a reduction in the need of induction if expectant management was allowed. There was no reduction in the caesarean section rate. We need more robust studies to come to a conclusion.

No. 233-Antibiotic Therapy in Preterm Premature Rupture of the Membranes

To review the evidence and provide recommendations on the use of antibiotics in preterm premature rupture of the membranes (PPROM). Outcomes evaluated include the effect of antibiotic treatment on maternal infection, chorioamnionitis, and neonatal morbidity and mortality. Published literature was retrieved through searches of Medline, EMBASE, CINAHL, and The Cochrane Library, using appropriate controlled vocabulary and key words (PPROM, infection, and antibiotics). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and new material incorporated in the guideline to July 2008. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Guideline implementation should assist the practitioner in developing an approach to the use of antibiotics in women with PPROM. Patients will benefit from appropriate management of this condition. This guideline has been reviewed and approved by the Infectious Diseases Committee and the Maternal Fetal Medicine Committee of the SOGC, and approved by the Executive and Council of the SOGC. The Society of Obstetricians and Gynaecologists of Canada.

Clinical value of polymerase chain reaction in detecting group B streptococcus during labor.

To reduce the intrapartum use of antibiotics in women with prolonged rupture of the membranes (PROM) by restriction of antibiotics to women who are colonized with group B streptococci (GBS), as identified with the Cepheid Gene Xpert polymerase chain reaction (PCR) for detecting GBS. We conducted a randomized controlled trial among full-term delivering women with PROM. Fifty-four women were enrolled, based on a power calculation with a significance level of 5% and a power of 95%. Twenty-seven women received the standard treatment (rectovaginal swab [RVS] for bacterial culture and antibiotics). For another 27 women PCR was performed on the RVS and antibiotics were used only when the PCR was positive. The primary outcome was reduction in antibiotic use, defined as the percentage of women who received antibiotics during labor. 54 Women were enrolled in the study between 1 May and 18 November 2014. There were no significant differences in baseline characteristics. In total, 10 of the 54 women were GBS positive (18.5%). Of those 10 women, three were identified on bacterial culture and seven on PCR. In the bacterial culture group all the women received antibiotics. In the PCR group 10 women (37%) received antibiotics (P = 0.002). Two false-positive PCR tests were identified. There were no false-negative PCR tests. Real-time identification of GBS on PCR reduces the intrapartum use of antibiotics in women with PROM.

The antibiotic sensitivity pattern and the use of antibiotics in women with asymptomatic bacteriuria in pregnancy

Background: Nitrofurantoin has been recommended as a first line therapy in Sri Lanka for urinary tract infections in pregnancy but it is not used frequently. Materials and Methods: At the Colombo South Teaching Hospital a descriptive cross sectional study was carried out from June 2015 to April 2016 on 98 consecutive pregnant women between eight to 24 weeks of gestation, residing in Colombo district and presenting with no urinary symptoms suggestive of urinary tract infection at the time of urine collection but having a positive urine culture (colony count of > 10 5 per ml of urine). The antibiotic sensitivity of the identified pathogens was studied. Results: The commonest organism found was Coliforms (n = 79) .The other organisms identified were Staphylococci (n = 10), Streptococci (n = 7) and Enterococci (n = 2). All the organisms were sensitive to Nitrofurantoin. However, Nitrofurantoin was used only in 57 women. Conclusion: As all the organisms were sensitive to Nitrofurantoin, prescribing practices need to be changed to include Nitrofurantoin as the first line of therapy for asymptomatic bacteriuria of pregnancy.

Antibiotics for prelabour rupture of membranes at or near term.

Prelabour rupture of the membranes (PROM) at or near term (defined in this review as 36 weeks' gestation or beyond) increases the risk of infection for the woman and her baby. The routine use of antibiotics for women at the time of term PROM may reduce this risk. However, due to increasing problems with bacterial resistance and the risk of maternal anaphylaxis with antibiotic use, it is important to assess the evidence addressing risks and benefits in order to ensure judicious use of antibiotics. This review was undertaken to assess the balance of risks and benefits to the mother and infant of antibiotic prophylaxis for PROM at or near term. To assess the effects of antibiotics administered prophylactically to women with PROM at 36 weeks' gestation or beyond, on maternal, fetal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014). All randomised trials that compared outcomes for women and infants when antibiotics were administered prophylactically for prelabour rupture of the membranes at or near term, with outcomes for controls (placebo or no antibiotic). Two review authors independently extracted the data and assessed risk of bias in the included studies. Additional data were received from the investigators of included studies. This update includes an additional two studies involving 1801 women, giving a total of four included studies of 2639 women. Whereas the previous version of this review showed a statistically significant reduction in endometritis with the use of antibiotics, no such effect was shown in this update (average risk ratio (RR) 0.34, 95% confidence interval (CI) 0.05 to 2.31). No differences were shown on the primary outcome measures of probable early-onset neonatal sepsis (average RR 0.69, 95%; CI 0.21 to 2.33); definite early-onset neonatal sepsis (average RR 0.57, 95% CI 0.08 to 4.26); maternal infectious morbidity (chorioamnionitis and/or endometritis) (average RR 0.48, 95% CI 0.20 to 1.15); stillbirth (RR 3.00, 95% CI 0.61 to 14.82); and perinatal mortality (RR 1.98, 95% CI 0.60 to 6.55), though the number of cases in the control group for these outcomes was low. There were no cases of neonatal mortality or serious maternal outcome in the studies assessed. Caesarean section was increased with the use of antibiotics (RR 1.33, 95% CI 1.09 to 1.61) as was duration of maternal stay in hospital (mean difference (MD) 0.06 days, 95% CI 0.01 to 0.11), largely owing to one study of 1640 women where repeat caesarean section, increased baseline hypertension and pre-eclampsia were evident in the antibiotic group, despite random allocation and allocation concealment.Subgroup analyses by timing of induction (early induction versus late induction) showed no difference in either probable or definite early-onset neonatal sepsis in the early induction group (RR 1.47, 95% CI 0.80 to 2.70 and RR 1.29, 95% CI 0.48 to 3.44, respectively) or the late induction group (RR 0.14, 95% CI 0.02 to 1.13 and RR 0.16, 95% CI 0.02 to 1.34, respectively), although there were trends toward reduced probable and definite early-onset neonatal sepsis in the late induction group. A test for subgroup differences confirmed a differential effect of the intervention on probable early-onset neonatal sepsis between the subgroups (Chi² = 4.50, df = 1 (P = 0.03), I² = 77.8%). No difference in maternal infectious morbidity (chorioamnionitis and/or endometritis) was found in either subgroup, though again there was a trend towards reduced maternal infectious morbidly in the late induction group (average RR 0.34, 95% CI 0.08 to 1.47). No differences were shown in stillbirth or perinatal mortality. The quality of the evidence for the primary outcomes using GRADE was judged to be low to very low. This updated review demonstrates no convincing evidence of benefit for mothers or neonates from the routine use of antibiotics for PROM at or near term. We are unable to adequately assess the risk of short- and long-term harms from the use of antibiotics due to the unavailability of data. Given the unmeasured potential adverse effects of antibiotic use, the potential for the development of resistant organisms, and the low risk of maternal infection in the control group, the routine use of antibiotics for PROM at or near term in the absence of confirmed maternal infection should be avoided.

Are we using too many antibiotics during pregnancy?

Are we using too many antibiotics during pregnancy?

Antibiotic Therapy in Preterm Premature Rupture of the Membranes

ObjectiveTo review the evidence and provide recommendations on the use of antibiotics in preterm premature rupture of the membranes (PPROM). OutcomesOutcomes evaluated include the effect of antibiotic treatment on maternal infection, chorioamnionitis, and neonatal morbidity and mortality. EvidencePublished literature was retrieved through searches of Medline, EMBASE, CINAHL, and The Cochrane Library, using appropriate controlled vocabulary and key words (PPROM, infection, and antibiotics). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and new material incorporated in the guideline to July 2008. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. ValuesThe evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) under the leadership of the principal authors, and recommendations were made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Benefits, Harms, and CostsGuideline implementation should assist the practitioner in developing an approach to the use of antibiotics in women with PPROM. Patients will benefit from appropriate management of this condition. ValidationThis guideline has been reviewed and approved by the Infectious Diseases Committee and the Maternal Fetal Medicine Committee of the SOGC, and approved by the Executive and Council of the SOGC. SponsorThe Society of Obstetricians and Gynaecologists of Canada. Recommendations1.Following PPROM at ≤ 32 weeks’ gestation, antibiotics should be administered to women who are not in labour in order to prolong pregnancy and to decrease maternal and neonatal morbidity. (I-A)2.The use of antibiotics should be gestational-age dependent. The evidence for benefit is greater at earlier gestational ages (< 32 weeks). (I-A)3.For women with PPROM at > 32 weeks’ gestation, administration of antibiotics to prolong pregnancy is recommended if fetal lung maturity can not be proven and/or delivery is not planned. (I-A)4.Antibiotic regimens may consist of an initial parenteral phase followed by an oral phase, or may consist of only an oral phase. (I-A)5.Antibiotics of choice are penicillins or macrolide antibiotics (erythromycin) in parenteral and/or oral forms. (I-A) In patients allergic to penicillin, macrolide antibiotics should be used alone. (III-B)6.The following two regimens may be used (the two regimens were used in the largest PPROM randomized controlled trials that showed a decrease in both maternal and neonatal morbidity): (1) ampicillin 2 g IV every 6 hours and erythromycin 250 mg IV every 6 hours for 48 hours followed by amoxicillin 250 mg orally every 8 hours and erythromycin 333 mg orally every 8 hours for 5 days (I-A); (2) erythromycin 250 mg orally every 6 hours for 10 days (I-A)7.Amoxicillin/clavulanic acid should not be used because of an increased risk of necrotizing enterocolitis in neonates exposed to this antibiotic. Amoxicillin without clavulanic acid is safe. (I-A)8.Women presenting with PPROM should be screened for urinary tract infections, sexually transmitted infections, and group B streptococcus carriage, and treated with appropriate antibiotics if positive. (II-2B)

Antibiotics for Preterm Rupture of the Membranes: A Systematic Review

We sought to evaluate the administration of antibiotics to pregnant women with preterm rupture of membranes (PROM). We collected data by using the Cochrane Controlled Trials Register and MEDLINE. We included randomized controlled comparisons of antibiotic versus placebo (14 trials, 6,559 women). Antibiotics were associated with a statistically significant reduction in maternal infection and chorioamnionitis. There also was a reduction in the number of infants born within 48 hours and 7 days and with the following morbidities: neonatal infection (relative risk [RR] 0.67, 95% confidence interval [CI] 0.52-0.85), positive blood culture (RR 0.75, 95% CI 0.60-0.93), use of surfactant (RR 0.83 95% CI 0.72-0.96), oxygen therapy (RR 0.88, 95% CI 0.81-0.96), and abnormal cerebral ultrasound scan before discharge from hospital (RR 0.82, 95% CI 0.68-0.99). Perinatal mortality was not significantly reduced (RR 0.91, 95% CI 0.75-1.11). A benefit was present both in trials where penicillins and erythromycin were used. Amoxicillin/clavulanate was associated with a highly significant increase in the risk of necrotizing enterocolitis (RR 4.60, 95% CI 1.98-10.72). The administration of antibiotics after PROM is associated with a delay in delivery and a reduction in maternal and neonatal morbidity. These data support the routine use of antibiotics for women with PROM. Penicillins and erythromycin were associated with similar benefits, but erythromycin was used in larger trials and, thus, the results are more robust. Amoxicillin/clavulanate should be avoided in women at risk of preterm delivery because of the increased risk of neonatal necrotizing enterocolitis. Antibiotic administration after PROM is beneficial for both women and neonates.

Antibiotics for prelabour rupture of membranes at or near term.

Prelabour rupture of the membranes at or near term (term PROM) increases the risk of infection for the woman and her baby. The routine use of antibiotics for women at the time of term PROM may reduce this risk. However, due to increasing problems with bacterial resistance and the risk of maternal anaphylaxis with antibiotic use, it is important to assess the evidence addressing risks and benefits in order to ensure judicious use of antibiotics. This review was undertaken to assess the balance of risks and benefits to the mother and infant of antibiotic prophylaxis for prelabour rupture of the membranes at or near term. To assess the effects of antibiotics administered prophylactically to women with prelabour rupture of the membranes at 36 weeks or beyond, on maternal, fetal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's specialised register of controlled trials (October 2001), the Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2001), MEDLINE (1965 to 2001). Other sources included contacting recognised experts and cross referencing relevant material. All randomised trials which compared outcomes for women and infants when antibiotics were administered prophylactically for prelabour rupture of the membranes at or near term, with outcomes for controls (placebo or no treatment). Assessment of trial quality and data extraction were undertaken independently by the two authors who then compared and resolved differences. Additional data were received from the investigators of included trials. Meta-analysis was undertaken using a fixed effects model and results are presented using relative risk (RR), risk difference (RD) and number needed to treat (NNT) (where appropriate) for categorical data, and mean difference (MD) for variables measured on a continuous scale. All results are presented with 95% confidence intervals (CI). The results of two trials, involving a total of 838 women, are included in this review. The use of antibiotics resulted in a statistically significant reduction in maternal infectious morbidity (chorioamnionitis or endometritis): RR 0.43 (95% CI 0.23, 0.82), RD -4% (95% CI -7%, -1%), NNT 25 (95% CI 14 -100). No statistically significant differences were shown for outcomes of neonatal morbidity. No clear practice recommendations can be drawn from the results of this review on this clinically important question, related to a paucity of reliable data. Further well designed randomised controlled trials are needed to assess the effects of routine use of maternal antibiotics for women with prelabour rupture of the membranes at or near term.

The prevention of preterm birth with the use of antibiotics.

Infection is a well recognised cause of spontaneous early preterm labour. Preterm labour of infective aetiology is refractory to the use of tocolytic agents and affected women have a higher risk of subsequent chorio-amnionitis and neonatal infection. Antibiotics used prophylactically for the prevention of preterm labour are more likely to be successful if given systemically. Intravaginal antibiotics are only likely to be of benefit if they are used early in the second trimester and in those women in whom there is full expression of abnormal genital tract flora (grade III bacterial vaginosis on Gram stain of vaginal secretions). Antibiotic treatment for women far removed from term offers significant benefit with respect to pregnancy prolongation. The value of extended antibiotic treatment is unclear since this may lead to the development of resistant bacterial strains. The evidence with respect to the use of antibiotics for women in preterm labour is inconsistent though there is a trend toward benefit.

A review of the role of trials of the use of antibiotics in women with preterm labor and intact membranes.

This updated review addresses the administration of antibiotics in women presenting with preterm labor and intact membranes as well as with bacterial vaginosis. 11 randomized controlled trials dealing with this question have been published since 1986. The results are disappointing. The probable reasons are the small number of patients in the different studies and universal use of antibiotics without performing amniocentesis to isolate the organisms involved.