The ORACLE trials on preterm prelabour rupture of membranes (PPROM) evaluated antibiotic use. The key finding regarding erythromycin versus co-amoxiclav was:
- A Erythromycin alone prolonged pregnancy and improved neonatal outcomes; co-amoxiclav increased risk of necrotizing enterocolitis ✓
- B Co-amoxiclav was superior to erythromycin in prolonging pregnancy
- C Neither antibiotic prolonged pregnancy in PPROM
- D Azithromycin was superior to erythromycin in this trial
Correct answer: A. Erythromycin alone prolonged pregnancy and improved neonatal outcomes; co-amoxiclav increased risk of necrotizing enterocolitis
Explanation
The ORACLE I trial showed erythromycin alone in PPROM significantly prolonged pregnancy and improved composite neonatal outcomes (reduced oxygen requirement, infection, cerebral abnormality). Co-amoxiclav (amoxicillin-clavulanate) was associated with a significantly increased risk of necrotizing enterocolitis in neonates. Consequently, erythromycin (or azithromycin as alternative) alone is recommended for antibiotic prophylaxis in PPROM; co-amoxiclav is specifically avoided.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.