Adverse events in women and children who have received intrapartum antibiotic prophylaxis treatment: a systematic review

Abstract

BackgroundAdverse events from intrapartum antibiotic prophylaxis (IAP) are poorly documented yet essential to inform clinical practice for neonatal group B Streptococcus (GBS) disease prevention. In this systematic review, we appraised and synthesised the evidence on the adverse events of IAP in the mother and/or her child.MethodsWe searched MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Cochrane, and Science Citation Index from date of inception until October 16th 2016. Reference lists of included studies and relevant systematic reviews were hand-searched. We included primary studies in English that reported any adverse events from intrapartum antibiotics for any prophylactic purpose compared to controls. The search was not restricted to prophylaxis for GBS but excluded women with symptoms of infection or undergoing caesarean section. Two reviewers assessed the methodological quality of studies, using the Cochrane Risk of Bias tool, and the Risk of Bias Assessment Tool for Nonrandomised Studies. Results were synthesised narratively and displayed in text and tables.ResultsFrom 2364 unique records, 30 studies were included. Despite a wide range of adverse events reported in 17 observational studies and 13 randomised controlled trials (RCTs), the evidence was inconsistent and at high risk of bias. Only one RCT investigated the long-term effects of IAP reporting potentially serious outcomes such as cerebral palsy; however, it had limited applicability and unclear biological plausibility. Seven observational studies showed that IAP for maternal GBS colonisation alters the infant microbiome. However, study populations were not followed through to clinical outcomes, therefore clinical significance is unknown. There was also observational evidence for increased antimicrobial resistance, however studies were at high or unclear risk of bias.ConclusionsThe evidence base to determine the frequency of adverse events from intrapartum antibiotic prophylaxis for neonatal GBS disease prevention is limited. As RCTs may not be possible, large, better quality, and longitudinal observational studies across countries with widespread IAP could fill this gap.Trial registration CRD42016037195.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-017-1432-3) contains supplementary material, which is available to authorized users.

Bacterial Load and Molecular Markers Associated With Early-onset Group B Streptococcus

“…Only two bacterial markers have been investigated in addition to bacterial load, and most of the evidence is published before 2000 and at high risk of bias. While IAP can reduce EOGBS morbidity, 34 there are potential harms associated with it, 35 and in current prevention approaches some mothers and their neonates may be unnecessarily treated and exposed to these potential harms. For example, in a screening program, up to 30% of GBS…”

Universal antenatal screening for group B streptococcus may cause more harm than good

“…A systematic review of 30 studies of intrapartum antibiotic prophylaxis found little evidence to quantify the potential harms to mothers and babies 46. Although a range of adverse effects was investigated, the 11 studies in which the authors explicitly stated that they examined prophylaxis for GBS were observational and at risk of bias.…”

Perinatal Streptococcus agalactiae Epidemiology and Surveillance Targets

“…Due to the recommended IAP, antibiotic exposure has become widespread, but the potential for resulting adverse events is unclear, as highlighted in a recent systematic review (125). While consistency is lacking for data on development of antimicrobial resistance and long-term adverse events as a result of IAP for GBS, infant microbiome disruption has been observed by numerous studies (126)(127)(128)(129)(130)(131)(132).…”