title: Intrapartum prophylaxis with ceftriaxone decreases rates of bacterial colonization and early-onset infection in newborns.
abstract: Because of high rates of neonatal gram-negative sepsis in many Latin American countries, we prospectively enrolled 784 high-risk pregnant women in a study designed to evaluate the effect of a single 1-g dose of ceftriaxone (n = 390) vs. that of no antibiotic prophylaxis (n = 394) on oral, rectal, and umbilical colonization and fatality rates among newborn infants. The mean ceftriaxone concentration in cord blood samples was 26 microgram/mL (range, 9-40 microgram/mL). Compared with infants of untreated mothers, children born to women who were given ceftriaxone were colonized at a lesser rate by gram-negative bacilli (54% vs. 35%; P < .001) and by group B streptococci (54% vs. 21%; P = .03) and endured significantly fewer sepsis-like illnesses in the first 5 days of life (8.1% vs. 3.1%; P = .004). There was also a tendency for them to have fewer episodes of culture-proven early-onset sepsis (2.8% vs. 0.5%; P = .06). Sepsis-related case-fatality rates (0.8% and 0.3%, respectively) were not significantly different. Although intrapartum administration of a single dose of ceftriaxone to high-risk mothers could be a safe and potentially useful strategy for reducing early-onset neonatal infections, additional information is required before this approach can be recommended for routine prophylaxis.
authors.affiliation: Department of Pediatrics, Hospital del Niño, Panama City, Panama.
authors.forename: X
authors.initials: X
authors.lastname: Sáez-Llorens
authors.forename: M S
authors.initials: MS
authors.lastname: Ah-Chu
authors.forename: E
authors.initials: E
authors.lastname: Castaño
authors.forename: L
authors.initials: L
authors.lastname: Cortés
authors.forename: A
authors.initials: A
authors.lastname: Torres
authors.forename: M
authors.initials: M
authors.lastname: Suárez
authors.forename: A
authors.initials: A
authors.lastname: Bissot
authors.forename: W
authors.initials: W
authors.lastname: Reyes
authors.forename: W B
authors.initials: WB
authors.lastname: Karp
authors.forename: G H
authors.initials: GH
authors.lastname: McCracken
mesh_terms: D001424:Bacterial Infections / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D002443:Ceftriaxone / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D015997:Neonatal Screening; D011247:Pregnancy; D011446:Prospective Studies; D018805:Sepsis / Q000401:mortality / Q000517:prevention & control* / Q000635:transmission; D016896:Treatment Outcome
chemical_list: D002443:Ceftriaxone