OBJECTIVE: The purpose of this study was to evaluate the impact of an interconception antibiotic regimen on endometrial microbial flora and histologic type. STUDY DESIGN: This was a secondary analysis of a double-blind randomized placebo-controlled trial of prophylactic metronidazole plus azithromycin that was given to 241 women (antibiotics, 118 women; placebo, 123 women) with a previous preterm delivery to prevent recurrent preterm delivery. Endometrial cultures and histologic types were obtained at randomization and 2 weeks after treatment. The prevalence of either the new acquisition or the resolution of individual microbes, categories of microbes, and plasma cell endometritis were compared by chi-square or Fishers' exact tests. RESULTS: Overall, antibiotics were associated with lower acquisition and higher resolution of microbes. Of women without Gardnerella at baseline, 14% of the women who received antibiotics vs 34% of the women who received placebo had positive endometrial culture for the organism after treatment (P < .05); of those women with G. vaginalis at baseline, 57% of the women who received antibiotics vs 33% of the women who received placebo (P < .05) had a negative follow-up culture. Other gram-negative rods, especially aerobes in general, manifested similar patterns. The impact on anaerobes and plasma cell endometritis was not definitive, but there was a trend toward the increased resolution of the former (77% vs 55%) and reduced acquisition of the latter (28% vs 50%). CONCLUSION: The antibiotic regimen prevented the acquisition and promoted the resolution, but not the eradication, of gram-negative rods such as G. vaginalis and the aerobic subcategory.
RCT Entities:
OBJECTIVE: The purpose of this study was to evaluate the impact of an interconception antibiotic regimen on endometrial microbial flora and histologic type. STUDY DESIGN: This was a secondary analysis of a double-blind randomized placebo-controlled trial of prophylactic metronidazole plus azithromycin that was given to 241 women (antibiotics, 118 women; placebo, 123 women) with a previous preterm delivery to prevent recurrent preterm delivery. Endometrial cultures and histologic types were obtained at randomization and 2 weeks after treatment. The prevalence of either the new acquisition or the resolution of individual microbes, categories of microbes, and plasma cell endometritis were compared by chi-square or Fishers' exact tests. RESULTS: Overall, antibiotics were associated with lower acquisition and higher resolution of microbes. Of women without Gardnerella at baseline, 14% of the women who received antibiotics vs 34% of the women who received placebo had positive endometrial culture for the organism after treatment (P < .05); of those women with G. vaginalis at baseline, 57% of the women who received antibiotics vs 33% of the women who received placebo (P < .05) had a negative follow-up culture. Other gram-negative rods, especially aerobes in general, manifested similar patterns. The impact on anaerobes and plasma cell endometritis was not definitive, but there was a trend toward the increased resolution of the former (77% vs 55%) and reduced acquisition of the latter (28% vs 50%). CONCLUSION: The antibiotic regimen prevented the acquisition and promoted the resolution, but not the eradication, of gram-negative rods such as G. vaginalis and the aerobic subcategory.
Authors: M A Klebanoff; J C Carey; J C Hauth; S L Hillier; R P Nugent; E A Thom; J M Ernest; R P Heine; R J Wapner; W Trout; A Moawad; K J Leveno; M Miodovnik; B M Sibai; J P Van Dorsten; M P Dombrowski; M J O'Sullivan; M Varner; O Langer; D McNellis; J M Roberts Journal: N Engl J Med Date: 2001-08-16 Impact factor: 91.245
Authors: William W Andrews; Robert L Goldenberg; John C Hauth; Suzanne P Cliver; Michael Conner; Alice R Goepfert Journal: Am J Obstet Gynecol Date: 2005-09 Impact factor: 8.661
Authors: H G Stiver; K R Forward; D L Tyrrell; G Krip; R A Livingstone; P Fugere; M Lemay; G Verschelden; J D Hunter; G D Carson Journal: Am J Obstet Gynecol Date: 1984-08-01 Impact factor: 8.661
Authors: Andrew B Onderdonk; Jonathan L Hecht; Thomas F McElrath; Mary L Delaney; Elizabeth N Allred; Alan Leviton Journal: Am J Obstet Gynecol Date: 2008-03-07 Impact factor: 8.661
Authors: Alexander Swidsinski; Hans Verstraelen; Vera Loening-Baucke; Sonja Swidsinski; Werner Mendling; Zaher Halwani Journal: PLoS One Date: 2013-01-08 Impact factor: 3.240
Authors: Nerea M Molina; Alberto Sola-Leyva; Maria Jose Saez-Lara; Julio Plaza-Diaz; Aleksandra Tubić-Pavlović; Barbara Romero; Ana Clavero; Juan Mozas-Moreno; Juan Fontes; Signe Altmäe Journal: Biomolecules Date: 2020-04-11