Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis.
Most cases of neonatal group B streptococcal disease with early onset have an intrapartum pathogenesis. Attack rates are increased substantially in infants born to mothers with prenatal group B streptococcal colonization and various perinatal risk factors (premature labor, prolonged membrane rupture, or intrapartum fever). In a randomized controlled trial, we studied the effect of selective intrapartum prophylaxis with ampicillin in 160 such high-risk women. In infants born to mothers who received intravenous ampicillin during labor, as compared with controls who received no treatment, neonatal colonization with group B streptococci was present in 8 of 85 (9 percent) versus 40 of 79 (51 percent; P less than 0.001), colonization at multiple (greater than or equal to 3) sites was observed in 3 of 85 (4 percent) versus 24 of 79 (30 percent; P less than 0.001), and bacteremia occurred in none of 85 versus 5 of 79 (6 percent; P = 0.024). The side effects of ampicillin were limited to a single episode of urticaria in a mother who had no history of penicillin allergy. We conclude that intrapartum ampicillin prophylaxis in women with positive prenatal cultures for group B streptococci who have certain perinatal risk factors can prevent early-onset neonatal group B streptococcal disease.
D000667:Ampicillin / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D005260:Female; D005831:Genital Diseases, Female / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology; D011897:Random Allocation; D012007:Rectum / Q000382:microbiology; D012306:Risk; D013290:Streptococcal Infections / Q000517:prevention & control* / Q000635:transmission; D013292:Streptococcus agalactiae / Q000302:isolation & purification; D014621:Vagina / Q000382:microbiology
D000667:Ampicillin