title: Intrapartum antibiotics for known maternal Group B streptococcal colonization.
abstract: BACKGROUND
  Maternal colonization with group B streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. Administration of intrapartum antibiotic prophylaxis (IAP) during labor has been associated with a reduction in early onset GBS disease (EOGBSD). However, treating all colonized women during labor exposes a large number of women and infants to possible adverse effects without benefit.
  
  
  OBJECTIVE
  To assess the effect of intrapartum antibiotics for maternal Group B haemolytic streptococci (GBS) colonization on mortality from any cause, from GBS infection and from organisms other than GBS.
  
  
  METHODS
  We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 11 March 2014.
  
  
  METHODS
  Randomized trials assessing the impact of maternal IAP on neonatal GBS infections were included.
  
  
  METHODS
  We independently assessed eligibility and quality of the studies.
  
  
  RESULTS
  We did not identify any new trials from the updated search so the results remain unchanged as follows.We included four trials involving 852 women.Three trials (involving 500 women) evaluating the effects of IAP versus no treatment were included. The use of IAP did not significantly reduce the incidence of all cause mortality, mortality from GBS infection or from infections caused by bacteria other than GBS. The incidence of early GBS infection was reduced with IAP compared to no treatment (risk ratio (RR) 0.17, 95% confidence interval (CI) 0.04 to 0.74, three trials, 488 infants; risk difference -0.04, 95% CI -0.07 to -0.01; number needed to treat to benefit 25, 95% CI 14 to 100, I² 0%). The incidence of LOD or sepsis from organisms other than GBS and puerperal infection was not significantly different between groups.One trial (involving 352 women) compared intrapartum ampicillin versus penicillin and reported no significant difference in neonatal or maternal outcomes.We found a high risk of bias for one or more key domains in the study methodology and execution.
  
  
  CONCLUSIONS
  Intrapartum antibiotic prophylaxis appeared to reduce EOGBSD, but this result may well be due to bias as we found a high risk of bias for one or more key domains in the study methodology and execution. There is lack of evidence from well designed and conducted trials to recommend IAP to reduce neonatal EOGBSD.Ideally the effectiveness of IAP to reduce neonatal GBS infections should be studied in adequately sized double-blind controlled trials. The opportunity to conduct such trials has likely been lost, as practice guidelines (albeit without good evidence) have been introduced in many jurisdictions.
authors.affiliation: Departments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and Evaluation, University of Toronto, 600 University Avenue, Toronto, Ontario, Canada, M5G 1X5.
authors.forename: Arne
authors.initials: A
authors.lastname: Ohlsson
authors.forename: Vibhuti S
authors.initials: VS
authors.lastname: Shah
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002353:Carrier State / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007743:Labor, Obstetric; D010400:Penicillin G / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D011247:Pregnancy; D013290:Streptococcal Infections / Q000517:prevention & control / Q000635:transmission*; D013292:Streptococcus agalactiae
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D000667:Ampicillin; D010400:Penicillin G