A scoping review of maternal antibiotic prophylaxis in low- and middle-income countries: Comparison to WHO recommendations for prevention and treatment of maternal peripartum infection.

Abstract

Sepsis is a leading cause of maternal death. Antimicrobials save lives, but inappropriate overuse increases risk of antimicrobial resistance. A scoping review comparing peripartum prophylactic antimicrobial use in low- and middle-income countries (LMICs) with WHO recommendations for prevention and treatment of maternal peripartum infection. Medline, Embase, Global Health, LILACS and the WHO Library databases were searched. Publications from LMICs since 2015 describing maternal prophlyactic antibiotics for group B streptococcus (GBS), preterm-prelabor rupture of membranes (PPROM), cesarean section, manual placental removal, and third/fourth-degree perineal tears. Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA guidelines. Owing to study heterogeneity, a narrative synthesis was performed. Of 1886 studies, 27 studies from 13 countries involving 43774 women met the eligibility criteria. Polymerase chain reaction screening for GBS is feasible, though limited financially. In PPROM, up to 42% of GBS isolates demonstrated erythromycin resistance. Evidence around cesarean section antimicrobial prophylaxis largely supports WHO recommendations; however, prolonged or multidrug regimens were reported. There is limited evidence to challenge current WHO recommendations to prevent peripartum infection in LMICs. However, implementation challenges exist. Given the emergence of antimicrobial resistance, research is needed to ensure that peripartum prophylactic antimicrobial choices remain effective.