CONCOMITANT USE OF GLUCOCORTICOIDS - A COMPARISON OF 2 METAANALYSES ON ANTIBIOTIC-TREATMENT IN PRETERM PREMATURE RUPTURE OF MEMBRANES

OBJECTIVE: This study was performed to investigate whether the demonst rated beneficial effects of antibiotics on maternal and neonatal morbi dity are altered when glucocorticoids are part of the treatment of pre term premature rupture of membranes. STUDY DESIGN: We performed a meta analysis of five published, randomized trials of antibiotic treatment in preterm premature rupture of membranes in which glucocorticoids wer e used as additional treatments and compared the results with those of a previously published metaanalysis of antibiotic treatment in preter m premature rupture of membranes, which excluded studies with concomit ant glucocorticoids. Primary outcomes included chorioamnionitis, postp artum endometritis, neonatal sepsis, respiratory distress syndrome, in traventricular hemorrhage, necrotizing enterocolitis, and neonatal mor tality. A logistic regression analysis was performed to test whether g lucocorticoids significantly influenced the effect of antibiotic treat ment. RESULTS: Among the 509 patients from five trials on antibiotic a nd glucocorticoid treatment published between 1986 and 1993 antibiotic therapy did not show any significant effect on any of the outcomes an alyzed. In contrast, antibiotic therapy without concomitant use of glu cocorticoids significantly reduced the odds of chorioamnionitis, postp artum endometritis, neonatal sepsis, and intraventricular hemorrhage b y 62%, 50%, 68%, and 50%, respectively. The logistic regression analys is showed that glucocorticoids significantly diminished the effect of antibiotic treatment on chorioamnionitis and neonatal sepsis. CONCLUSI ON: Glucocorticoids appear to diminish the beneficial effects of antib iotics in the treatment of preterm premature rupture of membranes. A c areful selection of patients who are likely to benefit from both thera pies is therefore recommended.