The ORACLE trial evaluated the use of antibiotics in preterm prelabour rupture of membranes (PPROM). Which antibiotic combination was found to be harmful and should be avoided in PPROM?

• A Erythromycin alone
• B Benzylpenicillin alone
• C Erythromycin combined with amoxicillin-clavulanate (co-amoxiclav) ✓
• D Azithromycin alone

Explanation

The ORACLE I trial found that erythromycin alone prolonged pregnancy and improved neonatal outcomes in PPROM. However, the combination of erythromycin with co-amoxiclav (amoxicillin-clavulanate) was associated with a significant increase in necrotising enterocolitis in neonates and is therefore contraindicated in PPROM. Erythromycin alone (or alternatively azithromycin) remains recommended.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.