7 responses to “GBS Cochrane Report”

  1. Amy Tuteur, MD

    This paper does not mean what you think it means. In fact, the paper appears essentially useless:

    1.The paper analyzes ONLY trials in the Cochrane Pregnancy and Childbirth Group's Trials Register. That amounts to 3 trials. This is only a very tiny fraction of papers on the effectiveness of antibiotics for group B strep.

    2.The three studies contain only 852 women. One study (352 women) compares two antibiotics to each other, so it cannot tell us about the effectiveness of antibiotic prophylaxis. Therefore, only 500 women were available for comparison of antibiotic prophylaxis vs. no antibiotics.

    Group B strep affects 1-2% of newborns of colonized mothers. The death rate of group B strep sepsis is in the range of 15%. Therefore, in any group of 250 women you would expect no neonatal deaths. Comparing two groups of 250 women and finding out that the DEATH rates from neonatal group B strep sepsis is the same tells us nothing. In order to produce valid results, a comparison study would need to enroll thousands of women in each arm.

    3.We have data on what happens in large populations. Group B strep is the leading cause of neonatal sepsis. Screening and prophylactic antibiotics have reduced the incidence of group B strep sepsis by 70%!

    In summary, the fact that 2 outdated and underpowered studies show no difference in death rates between treated and untreated groups tells us nothing. We know from copious additional data that antibiotic prophylaxis is effective in preventing group B strep sepsis and death.

  2. Nat

    Well, well, well. And I wonder how standard hospital management of labour and birth might increase infection risk as well, e.g. anything involving fingers and metal instruments up the vagina… Anyone done a study on that?

  3. Lauren

    "increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria". hhhmmmm how interesting. I just gave birth to my second baby 3 weeks ago – a beautiful perfect birth for me – no drugs and natural onset of labour. Everything and everyone was happy and healthy until my new daughter's slightly weepy eye became a full on infection colonised by MRSA. We are still battling it now. Maybe the IV antibiotics I had during that labour contributed to her being more susceptible to it…..

  4. Lisa Barrett

    Dr Amy, how interesting that you are still putting out the same drivel that makes you far more important and accurate than the Cochrane database.

  5. Lisa Barrett

    Dr Amy, how interesting that you are still putting out the same drivel that makes you far more important and accurate than the Cochrane database.

  6. Rose

    But Lisa don't you feel so important that Dr Amy has nothing better to do with her time?? Still!!!!

  7. AP

    I think Dr Amy has some very valid points regarding the power of the trials to give the answer to the question does antibiotics prevent GBS sepsis in the neonate or not.
    Whilst I certainly understand the concerns from the majority of people on this website not to interfere with the natural process of birth, when there are reasons to do so, it is worthwhile, as evidenced by the significantly improved maternal and neonatal outcomes in developed nations compared with 3rd world nations (sadly).
    Anecdotally, in our hospital, since screening for GBS, and giving IV antibiotics to GBS pos ladies during labour, GBS sepsis in neonates has become extremely rare, thankfully.
    Whilst Cochrane reviews are generally very good, they are still open to intepretation and criticism of the data.
    The short answer is, anecdotally, antibiotics have reduced serious GBS sepsis, and we need more much larger trials to answer the question as to whether this is across the board, or just due to chance. Unfortunately it will be difficult to do those trials because of current hospital protocols for GBS.
    If I was a lady in labour, I would be keen for anything that would reduce the chance (within reason) of sepsis in my baby, so give me antibiotics please.