title: Use of Cefazolin for Group B Streptococci Prophylaxis in Women Reporting a Penicillin Allergy Without Anaphylaxis.
abstract: OBJECTIVE
  To estimate the proportion of group B streptococci (GBS)-colonized women with a reported penicillin allergy without anaphylaxis receiving appropriate intrapartum antibiotic prophylaxis.
  
  
  METHODS
  We performed a retrospective cohort study of GBS-colonized, penicillin-allergic women delivering at term receiving intrapartum antibiotic prophylaxis during labor. Scheduled cesarean deliveries were excluded. The primary outcome was the proportion of women who received appropriate antibiotic coverage, defined as penicillin or cefazolin. Secondary outcomes included neonatal outcomes such as Apgar score, blood draws, antibiotic use, length of hospital stay, and composite morbidity.
  
  
  RESULTS
  Of 165 women reporting a penicillin allergy without anaphylaxis, 73 (44.2%) received an appropriate antibiotic and 92 (55.8%) received an inappropriate antibiotic. Of those receiving an inappropriate antibiotic, 56 (60.9%) were given clindamycin, 1 (1.1%) erythromycin, and 35 (38.0%) vancomycin. Women reporting rash as a penicillin reaction were more likely to receive cefazolin than another antibiotic (44 [60.3%] compared with 24 [26.1%], respectively; P<.001), whereas women whose reaction was not documented were less likely to receive cefazolin (18 [24.7%] compared with 63 [68.5%], respectively; P<.001). Among neonates whose mothers received appropriate compared with inappropriate antibiotics, there were no differences in Apgar score, number of blood draws, antibiotic use, length of hospital stay, or composite morbidity.
  
  
  CONCLUSIONS
  More than half of women allergic to penicillin without anaphylaxis received an antibiotic other than penicillin or cefazolin as prophylaxis, indicating poor adherence to national guidelines.
authors: Brown University and the Division of Maternal Fetal Medicine, Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School of Brown University, Providence, Rhode Island.
authors: Victoria A
authors: VA
authors: Briody
authors: Catherine M
authors: CM
authors: Albright
authors: Phinnara
authors: P
authors: Has
authors: Brenna L
authors: BL
authors: Hughes
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D002437:Cefazolin; D000075202:Contraindications; D004342:Drug Hypersensitivity; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D010406:Penicillins; D011247:Pregnancy; D012189:Retrospective Studies; D013292:Streptococcus agalactiae; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002437:Cefazolin