The ORACLE trial evaluated prophylactic antibiotics in preterm premature rupture of membranes (PPROM). Which antibiotic combination was shown to prolong latency significantly but was also associated with increased risk of necrotising enterocolitis (NEC) in the neonate?
- A Erythromycin alone
- B Ampicillin-sulbactam
- C Amoxicillin-clavulanate (co-amoxiclav) ✓
- D Azithromycin alone
Correct answer: C. Amoxicillin-clavulanate (co-amoxiclav)
Explanation
The ORACLE I trial (Lancet 2001) compared erythromycin, co-amoxiclav, both, or placebo in PPROM. Co-amoxiclav (amoxicillin-clavulanate) significantly prolonged pregnancy and reduced positive neonatal cultures, but was associated with a significantly increased risk of neonatal necrotising enterocolitis. Erythromycin alone prolonged latency without the NEC risk. As a result, co-amoxiclav is avoided in PPROM management, and erythromycin (or amoxicillin in penicillin-non-allergic women) is the recommended antibiotic.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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