In the ORACLE trial, which antibiotic regimen given to women with preterm premature rupture of membranes (PPROM) was associated with an increase in childhood cerebral palsy at 7-year follow-up?

• A Co-amoxiclav (amoxicillin-clavulanate) alone ✓
• B Erythromycin alone
• C Co-amoxiclav with erythromycin
• D Benzylpenicillin with erythromycin

Explanation

The ORACLE trial (2001, 2004 follow-up) showed that erythromycin given to women with PPROM prolonged pregnancy and reduced early infant morbidity. However, co-amoxiclav (amoxicillin-clavulanate) in any arm was associated with a significant increase in necrotising enterocolitis in neonates and, at 7-year childhood follow-up (ORACLE II), increased cerebral palsy. Co-amoxiclav is therefore contraindicated as routine antibiotic prophylaxis in PPROM. Erythromycin remains the preferred antibiotic.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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