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Single-dose penicillin prophylaxis against neonatal group B streptococcal infections. A controlled trial in 18,738
Insights
A single penicillin G dose at birth reduced Group B Strep disease in neonates. However, increased resistant infections in year one warrant caution before routine use.
Area of Science:
- Neonatal infections
- Microbiology
- Pharmacology
Background:
- Neonatal Group B streptococcal infections are severe with high fatality rates.
- Antimicrobial resistance can limit treatment efficacy.
Purpose of the Study:
- To evaluate the impact of a single intramuscular penicillin G dose at birth on Group B Strep colonization and disease rates.
- To assess the safety and efficacy of early-life penicillin administration.
Main Methods:
- A prospectively controlled study involving 18,738 neonates over 25 months.
- Measured maternal and infant Group B Strep colonization rates.
- Compared disease incidence between penicillin-treated and untreated infants.
Main Results:
- Penicillin treatment significantly reduced infant Group B Strep colonization (12.2% vs. 50% concordance).
- A significant decrease in disease caused by penicillin-susceptible organisms was observed (0.64 vs. 2.26 per 1000 live births).
- An initial increase in disease from penicillin-resistant pathogens was noted, but this effect was not sustained in the second year.
Conclusions:
- Parenteral penicillin at birth effectively reduces disease from susceptible Group B Strep.
- Routine use is not recommended due to potential increases in penicillin-resistant infections, requiring further investigation.
Abstract:
Neonatal Group B streptococcal infections may not respond to antimicrobial therapy and have been associated with case fatality rates of 50 per cent or greater. We evaluated the effect on colonization and disease rates of a single intramuscular dose of aqueous penicillin G given at birth in a prospectively controlled study of 18,738 neonates during a 25-month period. The colonization rate in the mothers was 26.6 per cent, with 50 per cent concordance in the untreated infants and 12.2 per cent in the penicillin-treated infants (P < 0.001). There was a significant decrease in the incidence of disease caused by all penicillin-susceptible organisms in the penicillin group (0.64 vs. 2.26 cases per thousand live births, P = 0.005). Disease caused by penicillin-resistant pathogens was increased in the penicillin-treated group during the first year of the study but was unaffected during the second year. Routine administration of parenteral penicillin at birth cannot be recommended until the effect on the incidence of disease caused by penicillin-resistant pathogens is fully defined.