New research shows that antibiotics given during apparent premature labor, without ruptured membranes or detectable infection, provide no benefit and may cause long-term harm to children
Cerebral palsy was present nearly twice as much in children at age 7 whose mothers received erythromycin during spontaneous preterm labor. An increase in risks was also seen with a combination of amoxicillin and clavulanate (co-amoxiclav), although it was lower. Among 1,611 children exposed in utero, 3.3% had cerebral palsy at age 7, compared with 1.7% of children in the control group or those exposed to co-amoxiclav alone.
In addition, the children were also at increased risk of functional impairment, which includes abnormalities such as difficulties with learning, walking, eyesight and other more extensive disabilities. 42.3% of children in the erythromycin group demonstrated some type of functional impairment.
For women with ruptured membranes but no signs of clinical infection, antibiotics neither improved nor increased risks.
The researchers calculated that one child would experience harm for every 64 mothers treated with erythromycin while 1 child would experience harm for every 79 mothers who received co-amoxiclav alone.
In the U.S., guidelines from ACOG recommend a combination of amoxicillin and erythromycin for women with preterm membrane rupture but neither the ACOG nor RCOG guidelines in England address the use of antibiotics for women in preterm labor whose membranes have not ruptured.
In response to the new study, Alison Bedford Russell, M.B.B.S., B.Sc., of Warwick Medical School, and P.J. Steer, M.D., of Imperial College London stated:
"The lessons to be learned seem clear: contrary to popular opinion ('might as well give them, they don't do any harm'), antibiotics are not risk free,".
The moral of the story: interventions should be used with discretion and follow the purpose to which research has shown them to be effective. More isn't always better.
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