Prophylactic antibiotics for the prevention of preterm birth in women at risk: A meta-analysis
Prophylactic antibiotics for the prevention of preterm birth in women at risk: A meta-analysis
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DOI：
10.1111/j.1479-828x.2007.00759.x
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发表时间：
2007-10-01
影响因子：
1.7
通讯作者：
Shennan, Andrew H.
中科院分区：
文献类型：
--
作者：
Simcox, Rachael;Sin, Wing-To A.;Shennan, Andrew H.
背景：早产（PTB）是围产期发病率和死亡率的主要决定因素。感染与早产的比例很大，但关于抗生素预防对高危孕妇的有效性还没有达成共识。目的：确定抗生素治疗是否能降低有PTB风险的无症状孕妇的早产风险。方法：通过MEDLINE的电子检索识别相关出版物（1966年至2005年8月）、科克伦妊娠和分娩组试验登记、科克伦对照试验中心登记（科克伦图书馆，第3期，2005年）和PubMed，使用与PTB和抗生素相关的多个检索词。发表的文献仅限于比较抗生素与安慰剂用于无症状非临产妇女的随机对照试验。使用随机效应模型，计算不同风险组的合并风险比。治疗效果和PTB.Results率之间的关联进行了分析：17个试验，12个确定妇女的阴道植物群异常的风险，三个妇女在以前的PTB和两个招募妇女的基础上，胎儿纤连蛋白阳性状态。无论用于评估风险的标准、给予的抗菌药物或治疗时的胎龄如何，抗生素治疗与PTB减少之间均无显著相关性（小于37周分娩的总体合并随机效应RR 1.03（95% CI 0.86-1.24））。用抗生素治疗有PTB风险的妇女并不能降低随后发生PTB的风险。
Background: Preterm birth (PTB) is the major determinant of perinatal morbidity and mortality. Infection is implicated in a large proportion of preterm deliveries, but there is no consensus regarding the efficacy of antibiotic prophylaxis for women at risk.Aim: To determine whether antibiotic treatment reduces the risk of preterm delivery in asymptomatic pregnant women at risk of PTB.Method: Relevant publications were identified via electronic searches of MEDLINE (1966 to August 2005), The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Central Register of Controlled Trials (the Cochrane Library, Issue 3, 2005) and PubMed using multiple search terms related to PTB and antibiotics. Publications were limited to randomised controlled trials comparing antibiotics with placebo given to asymptomatic non-labouring women. A random effect model was used, and combined risk ratios calculated for the various risk groups. Associations between treatment effect and the rate of PTB were analysed by meta-regression.Results: Seventeen trials were included, 12 identifying women at risk by abnormal vaginal flora, three on women at high risk from a previous PTB and two recruiting women based on positive fetal fibronectin status. There was no significant association between antibiotic treatment and reduction in PTB irrespective of criteria used to assess risk, the antimicrobial agent administered, or gestational age at time of treatment (overall combined random effect for delivery at less than 37 weeks RR 1.03 (95% CI 0.86-1.24)).Conclusions: Treating women at risk of PTB with antibiotics does not reduce the risk of subsequent PTB.