Here is the latest Cochrane report on antibiotics for GBS.
Intrapartum antibiotics for known maternal Group B streptococcal colonization
Women, men and children of all ages can be colonized with Group B streptococcus (GBS) bacteria without having any symptoms; bacteria are particularly found in the gastrointestinal tract, vagina and urethra. This is the situation in both developed and developing countries. About one in 2000 newborn babies have Group B streptococcus bacterial infections, usually evident as respiratory disease, general sepsis, or meningitis within the first week. The baby contracts the infection from the mother during labor. Giving the mother an antibiotic directly into a vein during labor causes bacterial counts to fall rapidly, which suggests possible benefits but pregnant women need to be screened. Many countries have guidelines on screening for GBS in pregnancy and treatment with antibiotics. Some risk factors for an affected baby are preterm and low birth weight; prolonged labor; prolonged rupture of the membranes (more than 12 hours); severe changes in fetal heart rate during the first stage of labor; and gestational diabetes. Very few of the women in labor who are GBS positive give birth to babies who are infected with GBS and antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections.
This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were around 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. The antibiotics ampicillin and penicillin were no different from each other in one trial with 352 GBS positive women. All cases of perinatal GBS infections are unlikely to be prevented even if an effective vaccine is developed.
In the face of more and more antibiotics given in maternity services to pregnant and birthing women surrounding the fear of GBS this is a turn up for the books.
Authors’ conclusions
Intrapartum antibiotic prophylaxis appeared to reduce EOGBSD, but this result may well be a result of 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.
Even though it is being acknowledged that antibiotics were introduced without good evidence and there is still no good evidence they feel it is too late to do anything about it. Shouldn’t we be rethinking our strategy over this?
You can find the whole report at Cochrane database
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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.
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?
"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…..
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.
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.
But Lisa don't you feel so important that Dr Amy has nothing better to do with her time?? Still!!!!
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.