Sometimes we're asked whether antibiotics in labour against GBS infection in the newborn baby do more harm than good. The source of concern is often an article published in 2008 in the Lancet, about the ORACLE II trial (see tinyurl.com/cqbq8ry). This reported the long-term effects of antibiotics given to women in threatened preterm labour. Their babies were followed up to age 7. The study found that low-dose, broad spectrum, oral antibiotics for up to ten days produced no benefits and were associated with about double the risk of the baby developing cerebral palsy for reasons that are not fully understood. In contrast to the regime used in the ORACLE II trial, women given antibiotics as preventative medicine against GBS infection in their newborn baby are given high-dose, narrow-spectrum (usually penicillin), intravenous antibiotics at 4 hourly intervals from the start of labour until the baby is born (so for hours not days). This has been shown to reduce the risk of early onset GBS disease by about 90%, without any known long-term side-effects on the baby.
There has been a lot of publicity recently about the inappropriate and excessive use of antibiotics (sparked by Prof Dame Sally Davies DBE, Chief Medical Officer, England - see tinyurl.com/cgxv2ms). We at GBSS are well aware of the risks of excessive use of antibiotics and have worked hard to stop misconceptions which result in their being given inappropriately - for example, in an erroneous attempt to eradicate carriage, or in a labour following a positive result from a previous pregnancy where the baby was unaffected.
Research has shown that intravenous antibiotics (ideally penicillin), given in labour to women whose babies are at higher risk of developing GBS infection, is highly effective at reducing the risk of GBS infection in newborn babies, without any known long-term side-effects on the baby, and no apparent tendency to increase antibiotic resistance. Indeed, GBS has remained sensitive to penicillin for over 60 years.
