title: Effectiveness of intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal disease.
abstract: OBJECTIVE
  To estimate the effectiveness against early-onset group B streptococcal (GBS) disease of intrapartum antibiotic prophylaxis among term and preterm deliveries, deliveries with fewer than 4 hours of antibiotics, and deliveries receiving clindamycin regimens.
  
  
  METHODS
  We performed a secondary analysis of the Birthnet cohort, a survey of 7,691 births to residents of the Active Bacterial Core surveillance system from 2003 to 2004. We used propensity score matching on covariates associated with prophylaxis and early-onset GBS disease to evaluate the effectiveness (1-risk ratio) of specific intrapartum antibiotic prophylaxis regimens against the disease end point.
  
  
  RESULTS
  The effectiveness of 4 or more hours of prophylaxis with penicillin or ampicillin was high among term (91%, 95% confidence interval [CI] +63% to +98%) and preterm (86%, 95% CI +38% to +97%) neonates. Effectiveness was significantly lower for clindamycin (22%, 95% CI -53% to +60%). The effectiveness of 2 or fewer to fewer than 4 hours of prophylaxis with penicillin or ampicillin before delivery (47%, 95% CI -16% to +76%) and the effectiveness of prophylaxis with penicillin or ampicillin fewer than 2 hours before delivery (38%, 95% CI -17% to +67%) were both lower than the effectiveness of prophylaxis durations at 4 or more hours.
  
  
  CONCLUSIONS
  Beta-lactam prophylaxis given 4 or more hours before delivery is highly effective for prevention of early-onset GBS disease. Prophylaxis of shorter durations or with clindamycin is less effective, reinforcing the need for health care providers to adhere to prevention recommendations, particularly for preterm deliveries, penicillin-allergic women, and neonates exposed to fewer than 4 hours of prophylaxis.
authors: National Center for Immunization and Respiratory Diseases, Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Tarayn
authors: T
authors: Fairlie
authors: Elizabeth R
authors: ER
authors: Zell
authors: Stephanie
authors: S
authors: Schrag
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D002981:Clindamycin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000382:microbiology; D013290:Streptococcal Infections / Q000151:congenital / Q000517:prevention & control*; D013292:Streptococcus agalactiae; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D000667:Ampicillin
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