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Preterm birth drugs

Steroids, neuroprotection, tocolysis and PPROM antibiotics.

Source: NICE NG25 · RCOG GTG 74

BetamethasoneLung maturity12 mg IM, 2 doses 24 h apart.⚠ Offer 24+0–33+6 wk; consider 34+0–35+6. Raises maternal glucose.

DexamethasoneLung maturity6 mg IM, 4 doses 12 h apart.⚠ Alternative to betamethasone.

Magnesium sulfateNeuroprotection4 g IV over 15 min, then 1 g/h until birth or for 24 h.⚠ Offer 24+0–29+6 wk; consider 30+0–33+6.

NifedipineTocolysis20 mg oral load, then MR 10–20 mg every 8 h for 48 h.⚠ Off-label. Avoid if hypotension or cardiac disease.

AtosibanTocolysis6.75 mg IV over 1 min; 18 mg/h for 3 h; then 6 mg/h up to 45 h (max 48 h).⚠ Second-line if nifedipine unsuitable.

ErythromycinPPROM250 mg orally four times daily for 10 days or until labour.⚠ Do not use co-amoxiclav (necrotising enterocolitis).

A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.