Regimens for prophylaxis for PPROM
The optimal antibiotic regimen for prophylaxis for preterm prelabour rupture of membranes (PPROM) is uncertain. A suitable regimen is:
1 amoxicillin 2 g intravenously, 6-hourly for 48 hours, followed by amoxicillin 250 mg orally, 8-hourly for a total of 7 days (intravenous + oral) or until delivery (whichever is sooner). For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment preterm prelabour rupture of membranes amoxicillin
OR
1 ampicillin 2 g intravenously, 6-hourly for 48 hours, followed by amoxicillin 250 mg orally, 8-hourly for a total of 7 days (intravenous + oral) or until delivery (whichever is sooner). For dosage adjustment in adults with kidney impairment, see ampicillin dosage adjustment preterm prelabour rupture of membranes ampicillin
PLUS (with either of the above regimens)
1 erythromycin (base) 250 mg orally, 6-hourly for 7 days or until delivery (whichever is sooner). For dosage adjustment in adults with kidney impairment, see erythromycin dosage adjustment preterm prelabour rupture of membranes erythromycin
OR
1 erythromycin (ethyl succinate) 400 mg orally, 6-hourly for 7 days or until delivery (whichever is sooner). For dosage adjustment in adults with kidney impairment, see erythromycin dosage adjustment. erythromycin
Some centres use oral erythromycin (at the dosage above) as monotherapy for 10 days, based on a large randomised controlled trial1. However, the methodology of the study has been criticised; the reduction in neonatal morbidity found with monotherapy may have been due to chance.
For patients hypersensitive to penicillins, give erythromycin as a single drug for 10 days.
If labour starts during or after the completion of PPROM prophylaxis, give prophylaxis for Streptococcus agalactiae (group B streptococcus) if indicated—see Prevention of neonatal Streptococcus agalactiae (group B streptococcus) disease.
If the patient is undergoing caesarean section, surgical prophylaxis is also required (see here for regimens).