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.