Why increase the dose of IAP for GBS: Are we doing more harm than good?

Summary

  • Background of EOGBSI and IAP
  • Incidence
  • CDC and increase- the evidence
  • What does this mean for women and babies?
  • What can midwives do?

Early onset group B streptococcal disease or infection (EOGBSI) remains a leading cause of neonatal mortality and morbidity worldwide. However, in conjunction with the widespread use of intrapartum antibiotic prophylaxis (IAP) the incidence of EOGBSI has declined. EOGBSI while serious, is rare. Despite a reported 80% decrease in EOGBSI since the introduction of IAP in the 1990s, the American Centers for disease and prevention (CDC) recommended an increase in antibiotic dose-from 1.2 grams to 3 grams stat then 1.5-1.8 grams 4 hourly until birth. This increase is based on 5 studies conducted between 1966 to the most recent in 2006. The aim of the change in dosage is to increase the amount of circulating antibiotic without causing neurotoxicity in the fetus or mother. But antibiotics are not without risk. As well as the risk of anaphylaxis, drug resistance and medicalisation of birth, emerging research suggests a link between antibiotics and long-term adverse health issues for the child. Midwives must urgently question the widespread use of IAP and this increase in dosage as a public health imperative.

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