There is also data showing that antibiotics are helpful during preterm labor for women who carry bacteria called group B streptococcus (GBS). About one in five women will carry GBS, and babies who get infected during labor and delivery can become very sick. Antibiotics can treat GBS and reduce complications of a subsequent infection in the newborn, but carry risks for the mother ( Ohlssen & Shah, 2009 ). Most care providers test women for the bacteria about a month before their due date. The test involves taking swab samples from the lower vagina and rectum. Because it can take two or three days for test results to be returned, the general practice is to go ahead and begin treating a woman for GBS before confirmation of infection if a woman is in preterm labor. Most doctors think that this presumptive treatment is justified because as many as one in four women test positive for GBS. Ampicillin and penicillin are the antibiotics most commonly used for treatment.
The pharmacological effect of Metopirone (metyrapone) is to reduce cortisol and corticosterone production by inhibiting the 11-β-hydroxylation reaction in the adrenal cortex. Removal of the strong inhibitory feedback mechanism exerted by cortisol results in an increase in adrenocorticotropic hormone (ACTH) production by the pituitary. With continued blockade of the enzymatic steps leading to production of cortisol and corticosterone, there is a marked increase in adrenocortical secretion of their immediate precursors, 11-desoxycortisol and desoxycorticosterone, which are weak suppressors of ACTH release, and a corresponding elevation of these steroids in the plasma and of their metabolites in the urine. These metabolites are readily determined by measuring urinary 17-hydroxycorticosteroids (17-OHCS) or 17-ketogenic steroids (17-KGS).
Corticosteroids may be used if NSAIDs and colchicine cannot be used. They may be injected directly into the affected joint (called an intraarticular injection) or they can be given as pills or by intramuscular injection. People who have multiple affected joints or who cannot take NSAIDs or colchicine may be given oral steroids. There may be an increased risk of recurrent gout attack (called a rebound attack) in people taking oral corticosteroids for severe attacks but reducing the dose too quickly. For this reason, corticosteroid dosing should be reduced slowly over a period of at least 10 to 14 days.