This will include those subjects randomized into the treatment arm, receiving the outpatient antibiotic course of azithromycin and amoxicillin prior to re-admission at viability (23 0/7 weeks gestation). They will receive a single, 500mg dose of Azithromycin given prior to discharge to home, followed by 250mg daily for 4 more days, and Amoxicillin 500mg orally TID for 7 days (first dose also being given prior to discharge home).

This will include those subjects randomized into the control arm and will not receive outpatient antibiotics prior to re-admission at viability (23 0/7 weeks gestation).

Rupture of Membranes; Delayed Delivery (Following Spontaneous Rupture)

Rupture of Membranes; Premature

Rupture of Membranes; Premature, Affecting Fetus

Preterm Birth

Preterm PROM (Pregnancy)

Preterm Labor

Azithromycin (500mg day one followed by 250mg per day for 4 more days) and amoxicillin (500mg orally three times daily for 7 days) for a total course of seven days of antibiotic therapy

Antibiotics, oral Azithromycin and oral Amoxicillin

Werth, Brian. "Macrolides - Infectious Diseases." Merck Manuals Professional Edition, July 2018

Hologic. (2018). Aptima Combo 2. Retrieved December 30, 2018

Hologic. (2018). Aptima® Trichomonas vaginalis Assay (Panther® System). Retrieved December 30, 2018

LabCorp. (2018). Wet Prep. Retrieved December 30, 2018

LabCorp. (2018). Complete Blood Count (CBC) with Differential. Retrieved December 30, 201

LabCorp. (2018). Group B Streptococcus Colonization Detection Culture. Retrieved December 30, 2018

Woman's Hospital

Latency Antibiotics in Previable PPROM, 18 0/7- 22 6/7 WGA

The Effect of Antibiotics on Latency in Previable Prelabor Rupture of Membranes Between 18 0/7 and 22 6/7 Weeks Gestational Age

The number of days from diagnosis of previable prelabor rupture of membranes to the date of delivery

The number of subjects in each arm that are able to reach 23 0/7 weeks gestational age following previable prelabor rupture of membranes between 18 0/7 and 22 6/7 weeks gestational age

All IPD that underlie results in a publication

Woman's

The treatment group will include those subjects randomized to the antibiotic arm versus the control arm, no antibiotics. The antibiotic arm will receive a single, 500mg dose of Azithromycin given prior to discharge to home, followed by 250mg daily for 4 more days, and Amoxicillin 500mg orally TID for 7 days (first dose also being given prior to discharge home). Both arms will receive patient pamphlets with study contacts, precautions, and graphs for daily temperature/symptom tracking. Weekly follow up with Maternal-Fetal Medicine, for both arms, will include history and physical exam, vital signs, and ultrasound for fetal well-being and measurement of AFI. Both arms will be re-admitted to the hospital either at 1) viability (23 0/7 weeks) or 2) clinical signs of placental abruption, preterm labor, chorioamnionitis or fetal demise. Re-admission of both arms at viability will include latency antibiotics, neuroprotective magnesium sulfate, and corticosteroids for fetal lung maturity.

All 38 urgent care clinics will implement CDC Core Elements of outpatient antibiotic stewardship as described above.

Antibiotic Side Effect

Behavioral Changes

The intervention is described above and includes components of leadership, action of policy and practice, tracking and reporting, and education and expertise.

CDC Core Elements of Outpatient Stewardship

Intermountain Medical Center

Improving Antibiotic Use in Urgent Care Facilities

Improving Antibiotic Use in Urgent Care Facilities Through Implementation and Evaluation of Core Elements of Outpatient Antibiotic Stewardship

Respiratory encounters are defined as an urgent care encounter for any ICD10 defined respiratory condition, excluding encounters with concomitant other infectious diseases codes.

The secondary outcome of antibiotic appropriateness will also be measured at the encounter level and will be estimated two ways: (i) in terms of rate of guideline-recommended antibiotics among selected respiratory diagnoses, and (ii) in terms of rate of antibiotic prescribing among respiratory diagnoses where no prescribing should occur (i.e., rate of "inappropriate" antibiotics).

The secondary outcome of diagnostic shifting will be measured at the provider level and characterize changes in the types of diagnoses used during respiratory encounters.

As data availability allows, a secondary outcome of patient satisfaction will be measured at the patient encounter level in terms of a validated, patient satisfaction score. Patient satisfaction will be assessed using the "rate your provider" question. This question asks patients to rate their provider on a scale of 1 - 10 (1 being the worst, 10 being the best). Patient satisfaction scores will be explored in patients that receive antibiotics for tier 2 and 3 respiratory conditions and those that do not receive antibiotics for tier 2 and 3 respiratory conditions.

Intermountain Health Care, Inc.

Centers for Disease Control and Prevention

This is a before/after study design. Its an implementation science project.

Bacterial Vaginosis

Medical device (registration number: 10-355-717, first licensed 12.08.2010)

Vaginal lactic acid and glycogen gel

Metronidazole

Dep. of Obstetrics and Gynecology, Bern University Hospital, Bern

Treatment Comparison of Antibiotics Versus Vaginal Lactic Acid in Non-pregnant Women With Acute Symptomatic Bacterial Vaginosis

Controlled, Multicenter, Randomized Parallel Group Pilot Study With 2 Treatment Arms in Non-pregnant Women With Acute Symptomatic Bacterial Vaginosis (BV)

This is a binary parameter indicating remission from BV.

Unpleasant vaginal discharge, unpleasant smell, vaginal pain, itching, burning, dryness

gonorrhea/febre

Latency Antibiotics in Previable PPROM, 18 0/7- 22 6/7 WGA

Improving Antibiotic Use in Urgent Care Facilities

Treatment Comparison of Antibiotics Versus Vaginal Lactic Acid in Non-pregnant Women With Acute Symptomatic Bacterial Vaginosis

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