http://story.news.yahoo.com/news?tmpl=story2&cid=571&ncid=751&e=6&u=/nm/
2002
0724/hl_nm/children_antibiotics_dc_1
Antibiotics Cut One Newborn Infection, Up Another
Wed Jul 24, 5:47 PM ET
By Amy Norton
NEW YORK (Reuters Health) - The use of antibiotics during labor and
delivery has sharply cut the risk of a type of a potentially
life-threatening blood infection among newborns in the US--but it may do
so at the price of boosting infections caused by another type of
bacteria, new research suggests.
Newborn sepsis caused by group B streptococci (GBS) bacteria is an
uncommon but potentially deadly blood infection. When these infections
arise shortly after birth--so-called early-onset sepsis--it is nearly
always due to GBS passed from the mother around the time of delivery.
Besides sepsis, such GBS transmission to newborns can cause pneumonia or
meningitis, an infection of the membranes surrounding the brain.
Because of this, in 1996 US health officials began recommending
antibiotic treatment during labor and delivery for women at risk of
transmitting GBS to their babies.
Now two new studies, reported in the July 25th issue of The New England
Journal of Medicine ( news - web sites), show the benefits and possible
downsides of this practice.
In one study of more than 13,000 very low birth weight newborns at 15 US
centers, researchers found that rates of early-onset GBS sepsis fell
markedly between the early and late 1990s. That was accompanied,
however, by a comparable rise in early-onset sepsis caused by E. coli
bacteria ( news - web sites)--bugs that, most of the time, were
resistant to the antibiotic ampicillin.
This raises the possibility that the decline in GBS sepsis--which has
been noted in other studies--will be "mirrored" by an increase in the
risk of infection with more-virulent bugs like E. coli, according to the
study authors, led by Dr. Barbara J. Stoll of Emory University in
Atlanta, Georgia.
But while the rise in E. coli sepsis in this study is "very troubling,"
Stoll told Reuters Health, the study findings "do not call into question
the current national guidelines for the selective use of intrapartum
antibiotics to prevent...transmission of GBS disease."
She called the drop in early-onset GBS sepsis in the US a "triumph."
Right now, GBS and E. coli account for most cases of newborn sepsis.
Because GBS is harmless to most adults, women who carry it typically
don't know it.
So, the US Centers for Disease Control and Prevention ( news - web
sites)
(CDC) recommends that doctors take one of two approaches to preventing
mother-to-child GBS transmission: testing women for GBS late in
pregnancy to see whether they're candidates for antibiotics during
labor; or offering treatment to women who, at the time of labor, have
risk factors for transmitting GBS if they have it. These risk factors
include premature delivery and rupture of the uterine membranes more
than 18 hours before delivery.
But in the second study, CDC investigators found that when women were
actually tested for GBS, their newborns were half as likely to develop
early-onset GBS disease as those born to unscreened women. And the
majority of women whose newborns developed early-onset disease did not
have risk factors for GBS transmission.
Overall, GBS disease was rare, with 0.5 cases per 1,000 live births, the
report indicates. Still, the fact that testing women for GBS was more
effective in preventing newborn illness suggests that universal
screening for the bacteria should be considered, according to the
researchers, led by Dr. Stephanie J. Schrag.
"We believe that this study will soon lead to new guidelines that will
call for routine screening late in pregnancy," Schrag said in a
statement issued by the CDC.
But the fact that in Stoll's study, the drop in early-onset GBS sepsis
was accompanied by a rise in E. coli sepsis is a "huge dilemma," Dr.
David A. Eschenbach of the University of Washington in Seattle told
Reuters Health.
Eschenbach explained that the concern with any widespread use of
antibiotics is that it allows pathogens that are not sensitive to the
drugs to thrive and proliferate.
"We eventually have to use some other means than antibiotics" to prevent
early-onset GBS disease, said Eschenbach, who wrote an editorial
published with the reports.
He called for more study of the GBS vaccines that are under
development--vaccines that, according to Eschenbach, "nobody's wanted to
study further or market" as yet.
But with this latest research, he said, more doctors may become
interested in new ways to fight newborn GBS infection.
"Now," Eschenbach said, "we have to consider the downside of antibiotics
in the long-term."
SOURCE: The New England Journal of Medicine 2002;347:233-239, 240-247,
280-281.
***********************************************
To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html
|
