For your info,

Neonatal group B Strep (GBS) (septicaemia or meningitis) is the commonest
life-threatening infection in the first week of life and has an estimated
incidence of 1 to 3 per thousand births.  It is a preventable disease in
many instances.  The preventative treatment of choice in
non-penicillin-allergic women is intravenous penicillin/ampicillin in labour.

In order to reduce maternal exposure to unnecessary antibiotic therapy
strategies have been developed to limit preventative antibiotics to "high
risk" labours.  Approximately 20% of women are gut or vaginal carriers of
GBS:  most of these women can be detected by screening (with a
vaginal-rectal swab) in the last 3 months of pregnancy.

High risk, GBS positive women should receive antibiotics intravenously in
labour.  High risk includes:

1)  Preterm labour
2)  Prolonged labour
3)  Multiple pregnancy
4)  Fever in labour
5)  Previous child with neonatal GBS infection
6)  Urine infection with GBS any time in pregnancy

Oral antibiotics are ineffective.

There are published guidelines from the Canadian Pediatric Society, Society
of Obstetricians and Gynaecologists of Canada, American Academy of
Pediatrics, all of which need revision in the light of the changing
situation in North America.

I do not know of any specific study looking at the risk of Candida infection
with a few doses of ampicillin but would be interested if anyone does.  I
would not accept anecdotal evidence of this as I suspect that a third of
mothers/infants are colonized with Candida whether or not antibiotics are
given.  I am happy to be educated on this issue if someone knows of some
peer-reviewed evidence.

Until we have a vaccine against GBS we may be stuck with treating an excess
of women in labour to prevent a disease with 5-20% mortality and 5-20%
handicap.  Most women would take the risk of antibiotics to protect their
newborn infant.

I hope that this helps clarify the evidence-based perspective.

Khalid


Khalid Aziz
Memorial University of Newfoundland