Main Article Content

Isabelle Goyer
Gabrielle Ferland
Ni Ruo
Caroline Morin
Marie-Sophie Brochet
Lucie Morin
Ema Ferreira


antibiotic, pregnancy, azithromycin, premature birth, preterm birth, preterm labour



Since 2006, the empiric use of azithromycin in women at risk of premature birth has become prevalent in our institution without any evidence of its efficacy. Although antibiotics can prolong pregnancy in preterm prolonged rupture of membranes, no published data are available for women with intact membranes.


To describe the purpose of adding azithromycin to the usual treatments (cerclage, tocolysis, rest, etc.) to prolong pregnancy in women with intact membranes who are at risk of or already in preterm labour .


A retrospective observational cohort study was done at a Mother-Child University Hospital Centre. Patients admitted to obstetric ward who received azithromycin between January 1 st , 2006 and August 1 st , 2010 were included. A total of 127 exposed women were matched to 127 controls through medical records and pharmacy software. A time-to-event analysis was done to compare gestational age at the time of the recorded composite event (delivery, or rupture of membranes, or second intervention to prolong pregnancy). To compare proportions of composite event at different time points, ? 2 tests were used.


Patients who received azithromycin had a more severe condition at presentation. Once adjusted for confounding factors, prolongation of pregnancy (HR =1.049; CI 95%: 0.774–1.421 [ p =0.758]) and gestational age at the event (HR=1.200; CI 95%: 0.894–1.609 [ p =0.225]) did not differ between the groups. The proportions of women with an event ?7 days post-diagnosis or ?37 gestational weeks were similar .


Azithromycin was added to medical therapy in a more at-risk population and no clear benefit was measured.

Abstract 223 | PDF Downloads 505


1. World Health Organization. The world health report. 2005;2005;79-101.
2. Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2006. National vital statistics reports; 57(7): National Center for Health Statistics. 2009.
3. Direction générale de la santé publique MSSS. État de santé de la population québécoise : quelques repères. Québec; 2008. Available at: http://publications.msss. pdf .
4. World Health Organization. WHO: recommended definitions, terminology and format for statistical tables related to the perinatal period and use of a new certificate for cause of perinatal deaths. Modifications recommended by FIGO as amended October 14, 1976. Acta Obstet Gynecol Scand 1977;56:247-53.
5. Steer P. The epidemiology of preterm labor. BJOG 2005.112(Supplement 1):1-3.
6. Lisonkova S, Jansen PA, Sheps SB, et al. The Effect of maternal age on adverse birth outcomes: does parity matter? J Obstet Gynaecol Can 2010;32(6):541-8.
7. Goldenberg RL, Culhane JF, Iams JD, et al Epidemiology and causes of preterm birth. Lancet 2008;371:75-83.
8. Dole N, Savitz DA, Hertz-Picciotto I, et al. Maternal stress and preterm birth. Am J Epidemiol 2003;157:14-24.
9. Bujold E, Pasquier JC, Simoneau J, et al. Intra-amniotic sludges, short cervix, and risk of preterm delivery. JOGC 2006;28(3):198-202.
10. Romero R, Espinoza J, Chaiworapongsa T, et al. Infection and prematurity and the role of preventive strategies. Semin Neonatol 2002;7(4):259-74.
11. Yoon BH, Romero R, Moon JB, et al. Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Obstet Gynecol 2001;185(5):1130-6.
12. Goldenberg AL, Hauth GC, Andrews WW. Intrauterine infection and preterm delivery. NEJM 2000;342(20):1500-7.
13. Gomez R, Romero R, Nien JK, et al. A short cervix in women with preterm labor and intact membranes: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 2005;182(3):678-89.
14. Daskalakis GJ. Prematurity prevention: the role of cerclage. Curr Opin Obstet Gynecol 2009;21(2):148-52.
15. King J, Flenady V. Prophylactic antibiotics for inhibiting preterm labour with intact membranes. Cochrane Database Syst Rev 2002;(4):CD000246.
16. Simcox R, Sin WA, Seed PT, et al. Prophylactic antibiotic for the prevention of preterm birth in women at risk: a meta-analysis. Aust N Z J Obstet Gynaecol 2007;47:368-77.
17. BerghellaV, Prasertcharoensuk W, Cotter A, et al. Does indomethacin prevent preterm birth in women with cervical dilatation in the second trimester? Am J Perinatol 2009;26(1):13-9.
18. Di Renzo GC, Roura LC & European Association of perinatal medicine-study Group on “Preterm Birth”. Guidelines for the management of spontaneous preterm labor. J Perinat Med 2006;34:359-66.
19. Rode L, Langhoff-Roos J, Andersson C, et al. Systematic review of progesterone for the prevention of preterm birth in singleton pregnancies. Acta Obstet Gynecol Scand 2009;88(11):1180-9.
20. Sivapalasingam S, Steigbigel NH. Macrolide, clindamycin and ketolides. In Principles and Practice of Infectious Diseases. Mandell GL, Bennett JE, Dolin R, et al Eds. 7th ed. Philadelphia: Elsevier; 2009.
21. Waites KB, Schelonka RL, Xiao L, et al. Congenital and opportunistic infections: Ureaplasma species and Mycoplasma hominis. Semin Fetal Noenatal Med 2009;14:190-9.
22. Yudin MH, Schalkwyk J, Van Eyk N, et al. Antibiotic therapy in preterm premature rupture of the membranes. J Obstet Gynaecol Can 2009;31(9):863-7, 868-74.
23. Rajaei M, Sultani M, Zare S. A randomised controlled trial of adjunctive erythromycin in women with idiopathic preterm labor. J Matern Fetal Neonatal Med 2006;19:17-20.
24. Kenyon SL, Taylor DJ, Tarnow-Mordi. Broad spectrum antibiotics for spontaneous preterm labor: the ORACLE II randomised trial. Lancet 2001;357:989-94.
25. Morency AM, Bujold E. The effect of second-trimester antibiotic therapy on the rate of preterm birth. J Obstet Gynaecol Can 2007;29:35-44.
26. Van den Broek NR, White SA, Goodall M, et al. The APPLe study : a randomised, community-based, placebo-controlled trial of azithromycin for the prevention of preterm birth, with meta-analysis. PLoS Med 2009;6(12):e1000191.
27. Luntamo M, Kulmala T, Mbewe B, et al. Effect of repeated treatment of pregnant women with sulfadoxine-pyrimethamine and azithromycin on preterm delivery in Malawi: a randomized controlled trial. J Trop Med Hyg 2010;83(6):1212-20.
28. Mercer B. Antibiotics in the management of PROM and preterm labor. Obstet Gynecol Clin N Am 2012;39(1):65-76.