Antibiotics Questioned in Spontaneous Preterm Labor

In women without infection, use is linked to functional impairment, cerebral palsy in children

THURSDAY, Sept. 18 (HealthDay News) -- Women who go into spontaneous preterm labor without ruptured membranes and no obvious signs of infection should not receive antibiotics because it may increase their children's subsequent risk of functional impairments and cerebral palsy, according to a study published online Sept. 18 in The Lancet.

Sara Kenyon, of the University of Leicester in the United Kingdom, and colleagues conducted a follow-up study of ORACLE II, a clinical trial that randomly assigned preterm labor patients without ruptured membranes and no obvious signs of infection to receive either erythromycin and/or amoxicillin-clavulanate or placebo. To determine the long-term effects on the patients' children, they assessed 3,196 children at age 7.

Compared to placebo, the researchers found that maternal use of erythromycin, with or without amoxicillin-clavulanate, was associated with an increased risk of mostly mild functional impairments such as poor eyesight, difficulty walking around the block, or struggling with day-to-day problem-solving (odds ratio 1.18). They also found that maternal use of antibiotics was associated with a higher rate of cerebral palsy (3.3 percent for erythromycin versus 1.7 percent for no erythromycin, and 3.2 percent for erythromycin plus amoxicillin-clavulanate versus 1.9 percent for no erythromycin plus amoxicillin-clavulanate).

"The results of this study add weight to the argument that we should be vigilant about interfering with systems we poorly understand in the absence of benefit," the authors write. "For example, there is little known about the effect of antibiotics on early patterns of microbial colonization of newborn children, which might have important, long-lasting consequences for early human development. Whatever the causal pathway, the findings in our study, together with concerns about the potential increase in neonatal mortality, support the opinion that antibiotics are not advisable in spontaneous preterm delivery without clinical signs of infection."

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