A scoping review of maternal antibiotic prophylaxis in low‐ and middle‐income countries: Comparison to WHO recommendations for prevention and treatment of maternal peripartum infection

Abstract

Background: Sepsis is a leading cause of maternal death. Antimicrobials save lives, but inappropriate overuse increases risk of antimicrobial resistance. Objective: A scoping review comparing peripartum prophylactic antimicrobial use in low-and middle-income countries (LMICs) with WHO recommendations for prevention and treatment of maternal peripartum infection. Search strategy: Medline, Embase, Global Health, LILACS and the WHO Library databases were searched. Selection criteria: Publications from LMICs since 2015 describing maternal prophlyactic antibiotics for group B streptococcus (GBS), preterm-prelabor rupture of membranes (PPROM), cesarean section, manual placental removal, and third/fourthdegree perineal tears.Data collection and analysis: Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA guidelines. Owing to study heterogeneity, a narrative synthesis was performed.Main results: Of 1886 studies, 27 studies from 13 countries involving 43 774 women met the eligibility criteria. Polymerase chain reaction screening for GBS is feasible, though limited financially. In PPROM, up to 42% of GBS isolates demonstrated erythromycin resistance. Evidence around cesarean section antimicrobial prophylaxis largely supports WHO recommendations; however, prolonged or multidrug regimens were reported. Conclusion:There is limited evidence to challenge current WHO recommendations to prevent peripartum infection in LMICs. However, implementation challenges exist.Given the emergence of antimicrobial resistance, research is needed to ensure that peripartum prophylactic antimicrobial choices remain effective.

The Prevalence and Factors Associated with Prophylactic Antibiotic Use during Delivery: A Hospital-Based Retrospective Study in Palembang, Indonesia

“…Studies in developing countries have reported that the proportion of deliveries that received antibiotics could reach up to 90% [ 16 , 17 ]. In Indonesia, study on prophylactic antibiotic use during delivery is very limited [ 18 ]. This situation immediately raised concern among experts, as previous studies had suggested that antibiotic exposure during labor and delivery may increase the risk of various adverse events to both the mother and newborn, including antibiotic-resistant bacterial infection, maternal and infant microbiome alteration, long-term functional impairment in children, and maternal anaphylaxis reaction [ 19 , 20 , 21 , 22 ].…”

“…These recommendations are supported by strong evidence on the impact and prevention of inappropriate use [ 14 , 23 , 24 ]. However, due to disparities in healthcare facilities, the guidelines for prophylactic antibiotic use in labor and delivery and the extent to which practitioners adopt these guidelines vary across countries, especially between high-income and low- to middle-income countries [ 14 , 18 ]. Despite the evidence that antibiotic use and inappropriate antibiotic prescriptions tend to be higher in low-income countries than in high-income countries, the practices of prophylactic antibiotic administration during delivery in low- to middle-income countries are not well characterized [ 25 , 26 ].…”

State of the art: Intrapartum antibiotics in cesarean section, the infant microbiota and allergic diseases

“…[26][27][28][29][30][31][32][33][34] Implementation of World Health Organization recommendations has been shown to vary widely between countries. 35,36 Whilst Australia and other developed countries may have standardized protocols, varying levels of adherence to these protocols have been reported. 37 Communicating the potential risks of pre-incision antibiotics to patients is challenging, given it is now considered the standard of care.…”

Health Systems Interventions for Prevention of Maternal Peripartum Infection in Low and Middle Income Countries: A Systematic Review

“…Overall, most of the studies on antibiotic prophylaxis have supported the current [2] recommendation on the use of antibiotics in the prevention of maternal peripartum infection. Implications for policy makers and practitioner's in health systems and for better public health outcomes is to recognize the importance of protocols on prophylaxis antibiotic use in maternity units based on the best available evidence, conformance to the standards of infection prevention and control as well as observance of surgical procedures [49]. In addition, policy makers and practitioners should consider systems approach in the prevention of maternal peripartum infections apart from antibiotic prophylaxis alone.…”