Prescription: Premature Rupture Of Membrane (PROM)

Casebank Prescription
1

Case 1

Where are you:
You are FY2 in Obstetrics and Gynaecology.

Who the patient is:
Mrs. Maria Smith, aged 30, is 34 weeks pregnant, presented with premature rupture of membranes.

Regular Medications:
Calcichew

Special note:
Allergic to penicillin. Had rash.

What you must do:
Prescribe Dexamethasone 12mg OD for 2 days
Erythromycin 250mg QDS PO for 10 days

Case 2

Where are you:
You are FY2 in Obstetrics and Gynaecology.

Who the patient is:
Mrs. Maria Smith, aged 30, is 34 weeks pregnant, presented with premature rupture of membranes.

Regular Medications:
Calcichew

Special note:
Allergic to penicillin. Had rash.

What you must do:
Prescribe Dexamethasone 12mg OD for 2 days
Erythromycin 250mg QDS PO for 10 days

Erythromycin:

  • Pregnant women can take erythromycin.
  • It’s 250 mg PO QDS for 10 days, in antibiotic section. Additional instructions: review in 48 hours.

Dexamethasone:

  • Erythromycin is the antibiotic of choice in PROM.
  • It’s 12 mg IM OD for 2 days or 10 mg IM BD for 1 day, in regular section. Give the dose as they ask you to give.
  • It’s only given for short course. So, you can give erythromycin and dexamethasone together.

Other drugs:

  • Metformin in regular section
  • Calcichew is 1 or 2 tablets OD, in regular section.
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I have checked new BNF as of February 2024, and it contains different doses and different timings.
How should we deal with them?

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Dexamethasone should be given in the once only section, not regular.

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Please could you share the new bnf

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Prophylaxis of intrauterine infection [in preterm prelabour rupture of membranes]for erythromycin

By mouth

Adult
250 mg 4 times a day for up to 10 days or until established labour, whichever is sooner.

Reduction of peri- and neonatal morbidity and mortality [in established preterm labour, planned preterm birth, or preterm prelabour rupture of membranes]for dexamethasone

By intramuscular injection

Adult
4.95 mg every 12 hours for 48 hours, to be given within 7 days prior to birth, treatment course may be repeated once as clinically indicated at least 7 days after completion of the first course, alternatively 9.9 mg every 24 hours for 48 hours, to be given within 7 days prior to birth, treatment course may be repeated once as clinically indicated at least 7 days after completion of the first course.

I agree the dex should be charted in the stat section

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Any interaction between erythromycin and dexamethazone? Should we prescribe penicillin or clindamycin instead? Saw in one youtube channel