Antibiotic Regimen for Premature Rupture of Membranes (PROM)

Antibiotic Recommendations

For women with PPROM at 20-23 6/7 weeks, antibiotics can be considered to prolong latency and reduce neonatal morbidity, with the same regimen as above recommended based on clinical evidence 1
For women with PPROM at ≥24 weeks, antibiotics are strongly recommended for expectant management 1

For women with PPROM and unknown GBS status, obtain vaginal-rectal swab for GBS culture and start antibiotics for latency or GBS prophylaxis 2
If receiving antibiotics for latency that include ampicillin 2g IV once, followed by 1g IV every 6 hours for at least 48 hours, this is adequate for GBS prophylaxis 3, 4
For women with PPROM who are GBS positive, continue antibiotics until delivery if in labor 4
For women with PPROM who are GBS negative, no GBS prophylaxis is needed at onset of true labor, and a negative GBS screen is considered valid for 5 weeks 4

Amoxicillin/clavulanic acid should NOT be used due to increased risk of necrotizing enterocolitis in neonates 1
Azithromycin can be used as an alternative to erythromycin when erythromycin is not available 1
Oral antibiotics alone are not adequate for GBS prophylaxis 3
GBS prophylaxis should be discontinued at 48 hours for women with PPROM who are not in labor 3
If GBS screen results become available during the 48-hour period and are negative, GBS prophylaxis should be discontinued at that time 3