Antibiotics at delivery: do the benefits outweigh the risks?

Abstract

Antibiotics administered just before delivery or during the intrapartum period is common globally and recommendations for increased use continue to expand. Before the introduction of maternal screening and treatment for Group B Streptococcus (GBS) colonization to prevent neonatal GBS sepsis in the 1990's, maternal antibiotic treatment at delivery was used rarely, usually for confirmed maternal infections. With maternal screening for GBS, including a 20-25% positivity rate in the United States (US), antibiotic use at delivery increased substantially.(1) Antibiotics at delivery were subsequently recommended for women with prolonged membrane rupture and preterm labor. Recommendations expanded further with evidence that antibiotics reduced post-partum maternal infections associated with cesarean delivery.(2) And now, following a trial in The Gambia that suggested reduced maternal and neonatal infections, several large trials in low- and middle-income countries (LMICs) are evaluating whether widespread azithromycin treatment, not only for women undergoing cesarean delivery, but among all pregnant women, reduces maternal and neonatal morbidity and mortality.(3).