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To the Editor.—Dr Mercer et al¹ demonstrated decreased infant infection and prolonged pregnancy if antimicrobial treatment is given after preterm premature rupture of the membranes (PPROM). As the authors indicate, intrauterine infection is thought to cause many cases of PPROM. However, their study did not separate PPROM due to ascending infection from PPROM due to other causes.

Antimicrobials may work by treating active ascending infection or by preventing ascending infection before it occurs or both. There are at least 2 ways to address this issue. One would be to stratify the study data by presence or absence of histologic chorioamnionitis. Another would be to stratify by hour of membrane rupture. We have demonstrated that PPROM is highly circadian in the absence of membranitis, and noncircadian when membranitis is present.² Thus, with PPROM, membranitis was least likely between midnight and 8 AM, most likely between noon and 8 PM, and . . . [Full Text of this Article]

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RELATED ARTICLE

Antibiotic Therapy for Reduction of Infant Morbidity After Preterm Premature Rupture of the Membranes: A Randomized Controlled Trial
Brian M. Mercer, Menachem Miodovnik, Gary R. Thurnau, Robert L. Goldenberg, Anita F. Das, Risa D. Ramsey, Yolanda A. Rabello, Paul J. Meis, Atef H. Moawad, Jay D. lams, J. Peter Van Dorsten, Richard H. Paul, Sidney F. Bottoms, Gerald Merenstein, Elizabeth A. Thom, James M. Roberts, and Donald McNellis
JAMA. 1997;278(12):989-995.
ABSTRACT