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Infectious diseases

Antibiotics should be offered to all women in pre-term labour

The number of cases of early onset Group B streptococcal disease appears to be rising in the UK, with around 500 babies developing the condition in 2015, according to the Royal College of Obstetricians and Gynaecologists.

All women who go into labour before 37 weeks of pregnancy should be offered antibiotics to prevent a potential transmission of Group B streptococcal (GBS) disease to their babies, the Royal College of Obstetricians and Gynaecologists (RCOG) has said in revised guidelines.

GBS is the most frequent cause of severe early infection in newborn babies who are less than a week old. It consists of bacteria that occur naturally in the digestive system and lower vaginal tract of around a quarter of all women at any one time, and normally causes no harm.

Women who carry GBS can pass it on to their babies during labour; while the majority of newborns will suffer no serious effects, a small proportion will develop an infection and can become seriously ill.

“We welcome this major update to the RCOG’s clinical guidance, which represents a significant improvement in the procedure to prevent Group B Strep infection in newborn babies” said Jane Plumb, chief executive of Group B Strep Support. “When fully implemented across the UK, we believe this change will make a real difference and we will see the rate of infections start to fall.”

The number of cases of early onset GBS appears to be rising in the UK, with around 500 babies developing the condition in 2015, according to the RCOG. Prompt treatment will lead to full recovery in 17 out of 20 diagnosed babies, but two in 20 with the infection will recover with some level of permanent disability, and one in 20 will die. 

Premature labour increases the risk of women passing GBS to their baby, with 22% of all cases of early onset GBS in 2015 found in babies born prematurely. Around one in 500 preterm babies will develop early onset GBS disease, compared with a risk of one in 2,000 for babies born at full-term. The mortality rate from infection is also higher at 20–30% for babies born before 37 weeks, compared with 2–3% for babies born at term.

The revised guideline does not recommend universal bacteriological screening for GBS, after the National Screening Committee found little clear evidence to support routine testing.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20203588

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