Chatzakis C, et al. - In view of the recommendation of routinely providing prophylactic antibiotics for preterm prelabor rupture of membranes, researchers sought to compare the effect of different antibiotic regimens on perinatal outcomes and to evaluate the quality of the current evidence via performing a network meta-analysis. They included 20 studies (7,169 participants randomized to 15 therapeutic regimens) in this network meta-analysis. Relative to placebo/no treatment, clindamycin + gentamycin, penicillin, ampicillin/sulbactam + amoxicillin/clavulanic acid, ampicillin and erythromycin + ampicillin + amoxicillin were superior for the outcome of chorioamnionitis. For neonatal sepsis, the only effective drug was erythromycin. For respiratory distress syndrome, the only effective regimens were clindamycin + gentamycin and erythromycin + ampicillin + amoxicillin, whereas for reducing the rates of Grade-3/4 intraventricular hemorrhage, ampicillin and penicillin were effective. However, none of the antibiotics display clear and consistent superiority relative to other antibiotics, and most are not superior to placebo/no treatment for other outcomes. The evidence gained is of the overall low quality and requires to be updated, as microbial resistance may have developed for some antibiotics, while others are underrepresented in the existing evidence.