Antibiotic prophylaxis and treatment regimens
The departmental antibiotic protocol included: antimicrobial prophylaxis (2 g cefazolin intravenously 30 min before skin incision) in cases of caesarean deliveries. If PPROM occurred prior to 34 weeks and there were no signs of chorioamnionitis or foetal distress, the pregnancies were managed expectantly until 35 weeks at which time they were routinely induced. Expectant management included a five-day antibiotic course in accordance with The Mercer protocol for PPROM. This consisted of intravenous treatment with 8 g/d of ampicillin for 48 h and a single parenteral dose of 500 mg of azithromycin followed by five days of parenteral treatment with 1.5 g/d of amoxicillin. If a suspicion of chorioamnionitis arose, treatment with intravenous ampicillin (8 g/d) and gentamycin (5 mg/kg/d) was initiated. Penicillin-based antibiotics and intravenous clindamycin (900 tid) were administered after the diagnosis of a GAS-related illness had been established.