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Single-dose penicillin prophylaxis of neonatal group-B-streptococcal disease
Insights
A single dose of penicillin G effectively prevented neonatal group-B streptococcal infections. While penicillin-resistant infections saw a slight increase, overall mortality remained comparable between groups.
Area of Science:
- Neonatal infections
- Infectious disease prevention
- Pharmacology
Background:
- Neonatal group-B streptococcal infections pose a significant health risk.
- Preventive strategies are crucial to reduce neonatal morbidity and mortality.
- Penicillin G is a widely used antibiotic for bacterial infections.
Purpose of the Study:
- To evaluate the efficacy of a single dose of aqueous penicillin G in preventing neonatal group-B streptococcal infections.
- To compare the incidence of infections and mortality rates between penicillin-treated infants and a control group.
Main Methods:
- A randomized study involving 16,082 infants receiving a single dose of penicillin G within one hour of delivery.
- A control group of 15,976 infants received tetracycline ophthalmic ointment.
- Infections and mortality were monitored over a 41-month period.
Main Results:
- Penicillin G significantly reduced group-B streptococcal systemic infections (0.6 vs 1.7 per 100 live births, p = 0.004).
- A slight, though not statistically significant, increase in penicillin-resistant infections was observed in the penicillin group (2.2 vs 1.6 per 1000 live births, p = 0.32).
- Overall mortality rates were not significantly different between the groups.
Conclusions:
- A single dose of penicillin G is effective in preventing neonatal group-B streptococcal infections.
- The observed increase in penicillin-resistant infections warrants further investigation, particularly regarding early study period events.
- Penicillin G administration at birth did not affect gonococcal ophthalmia or conjunctivitis incidence.
Abstract:
The efficacy of a single dose of aqueous penicillin G in preventing neonatal group-B streptococcal infections was demonstrated in a randomised study conducted over 41 months. 16 082 infant received a single dose of penicillin within one hour of delivery, and 15 976 infants who received tetracycline ophthalmic ointment served as the control group. Group-B streptococcal systemic infections were significantly less common in the penicillin-treated infants (0.6 vs 1.7 cases per 100 live birth, p = 0.004). The incidence of infection caused by penicillin-resistant pathogen was insignificantly increased in the penicillin group (2.2 vs 1.6 cases per thousand live birth, p = 0.32). this difference was accounted for almost completely by the events of the first 12 months of the study period when, for unexplained reasons, there was a considerable increase in the number of penicillin-resistant infections in the penicillin group (3.6 vs 1.4 cases per 1000 live births, p = 0.09). The mortality associated with penicillin-susceptible pathogens was higher in the control group (0.1 vs 0.4 per 1000 live births, p = 0.18). However, the mortality associated with penicillin-resistant pathogens was increased in the penicillin (0.4 vs 1.0 per 1000 live births, p = 0.06). The combined mortality rates for all pathogens were not significantly different (1.1 vs 0.7 per 1000 liver births, p = 0.27, for the penicillin and control groups, respectively) and were nearly equivalent when the excess number of deaths associated with penicillin-resistant infections in the penicillin group during the first study year was excluded from analysis. The incidence of gonococcal ophthalmia and conjunctivitis was unaffected by the use of intramuscular penicillin at birth.