Antimicrobial prophylaxis in pregnancy: a randomized, placebo-controlled trial with cefetamet-pivoxil in pregnant women with a poor obstetric history.

OBJECTIVE: This study was undertaken to measure the impact of a single oral dose of cefetamet-pivoxil on pregnancy outcome in a population with substantial rates of low birth weight and high prevalence rates of maternal infections. STUDY DESIGN: A total of 320 pregnant women with a poor obstetric history, defined as a history of low birth weight or stillbirth, were randomized to receive a single oral dose of 2 gm of cefetamet-pivoxil or a placebo at a gestational age between 28 and 32 weeks. Patients were assessed at delivery and 1 week post partum for pregnancy outcome, postpartum endometritis, human immunodeficiency virus-1 and gonococcal infections. RESULTS: A total of 253 (79%) women gave birth at the maternity hospital, of whom 210 (83%) attended the follow-up clinic. Overall, 18.1% of these pregnant women were human immunodeficiency virus-1 seropositive, whereas 9.5% had antibodies against Treponema pallidum. There was a significant difference between cefetamet-pivoxil- and placebo-treated women in infant birth weight (2927 gm vs 2772 gm, p = 0.03) and low birth weight (< 2500 gm) rates (18.7% vs 32.8%, p = 0.01, odds ratio 2.1, 95% confidence interval 1.2 to 3.8). The stillbirth rate was 2.2% in the cefetamet-pivoxil group and 4.2% in the placebo group (not significant). Postpartum endometritis was found in 17.3% in the intervention arm versus 31.6% in the placebo group (p = 0.03, odds ratio 2.2, 95% confidence interval 1.1 to 7.6). Neisseria gonorrhoeae was isolated from the cervix in 5 of 103 (4.9%) women in the intervention and in 14 of 101 (13.9%) in the placebo group (p = 0.04, odds ratio 3.2, 95% confidence interval 1.1 to 10.5). CONCLUSION: A single oral dose of cefetamet-pivoxil administered to pregnant women with a poor obstetric history seemed to improve pregnancy outcome in this population with high rates of maternal infections. Larger studies should be carried out to examine the public health impact, the feasibility, and the overall cost/benefit ratio of this intervention.

Financial benefit from the eradication of swine dysentery.

Swine dysentery was eradicated from a 270 sow herd by using medication in conjunction with cleaning and disinfection, without reducing the herd size. The feed conversion efficiency, cost per kg liveweight gain and veterinary costs in the herd were compared with similar Meat and Livestock Commission recorded herds before swine dysentery entered the farm, while it was present and after its eradication. During the four years when the disease was endemic in the herd the feed conversion efficiency deteriorated by 0.58, equivalent to 7.31 pounds per pig, the cost per kg liveweight gain was 15 per cent higher and the costs of veterinary care and medicines were 1.38 pounds per pig greater. Although there were pigs with clinical swine dysentery in the herd during the four year period, the poor production figures were attributed mainly to subclinical disease. The cost of eradicating the disease was more than 20,000 pounds but this sum was recouped within 12 months by the improved production and reduced drug usage. The chances of success of such a programme have been estimated to be between 54 and 90 per cent.

Investigation into the spread of swine dysentery in 25 herds of East Anglia and assessment of its economic significance in five herds.

Of 25 outbreaks of swine dysentery investigated, 22 were considered to have resulted from the purchase of pigs from farms known to be infected, two from the introduction of Treponema hyodysenteriae on the boots of the stockman, and one from the accidental entry of infected pigs into a 'closed' herd. The hidden costs of swine dysentery in terms of an increased food conversion ratio may be more than four times the cost of medication. A method of halting the spread of disease is described.