Is it time to revisit routine administration of antibiotic for preterm prelabor rupture of membranes?

Preterm prelabor rupture of membranes (pPROM) is the precursor of up to 40% of preterm deliveries and an independent risk factor for neonatal disease, death and long-term pulmonary and neurodevelopmental deficits. A significant proportion of cases of pPROM are infection driven, although these are difficult to delineate in clinical practice. Our understanding of the natural history of intrauterine infection/inflammation is rudimentary at best. Even less is our knowledge of the influence of antibiotic therapy on the course of intrauterine infection. Yet, evidence that suggested that antibiotic therapy for pPROM delayed preterm delivery and reduced maternal and neonatal morbidity was adopted, and routine administration of broad-spectrum antibiotic is now part of the standard of care for patients with pPROM. This article evaluates the findings of a recent small but, in my opinion, very important study that aimed to determine whether antibiotic administration to the mother eradicated intra-amniotic infection and/or inflammation, both recognized potent risk factors for preterm delivery and adverse neonatal/childhood outcomes.