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Adverse events in women and children who have received intrapartum antibiotic prophylaxis treatment: a systematic review.

Seedat, Farah and Stinton, Chris and Patterson, Jacoby and Geppert, Julia and Tan, Bee K and Robinson, Esther R and McCarthy, Noel Denis and Uthman, Olalekan A and Freeman, Karoline and Johnson, Samantha Ann and Fraser, Hannah and Brown, Colin Stewart and Clarke, Aileen and Taylor-Phillips, Sian (2017) Adverse events in women and children who have received intrapartum antibiotic prophylaxis treatment: a systematic review. BMC pregnancy and childbirth, 17 (1). p. 247. ISSN 1471-2393.

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Abstract

BACKGROUND

Adverse events from intrapartum antibiotic prophylaxis (IAP) are poorly documented yet essential to inform clinical practice for neonatal group B Streptococcus (GBS) disease prevention. In this systematic review, we appraised and synthesised the evidence on the adverse events of IAP in the mother and/or her child.

METHODS

We searched MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Cochrane, and Science Citation Index from date of inception until October 16th 2016. Reference lists of included studies and relevant systematic reviews were hand-searched. We included primary studies in English that reported any adverse events from intrapartum antibiotics for any prophylactic purpose compared to controls. The search was not restricted to prophylaxis for GBS but excluded women with symptoms of infection or undergoing caesarean section. Two reviewers assessed the methodological quality of studies, using the Cochrane Risk of Bias tool, and the Risk of Bias Assessment Tool for Nonrandomised Studies. Results were synthesised narratively and displayed in text and tables.

RESULTS

From 2364 unique records, 30 studies were included. Despite a wide range of adverse events reported in 17 observational studies and 13 randomised controlled trials (RCTs), the evidence was inconsistent and at high risk of bias. Only one RCT investigated the long-term effects of IAP reporting potentially serious outcomes such as cerebral palsy; however, it had limited applicability and unclear biological plausibility. Seven observational studies showed that IAP for maternal GBS colonisation alters the infant microbiome. However, study populations were not followed through to clinical outcomes, therefore clinical significance is unknown. There was also observational evidence for increased antimicrobial resistance, however studies were at high or unclear risk of bias.

CONCLUSIONS

The evidence base to determine the frequency of adverse events from intrapartum antibiotic prophylaxis for neonatal GBS disease prevention is limited. As RCTs may not be possible, large, better quality, and longitudinal observational studies across countries with widespread IAP could fill this gap.

TRIAL REGISTRATION

CRD42016037195 .

Item Type: Article
Subjects: WP Gynaecology. Women’s health
Divisions: Clinical Support > Pathology
Womens and Childrens > Gynaecology
Womens and Childrens > Obstetrics
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Depositing User: Preeti Puligari
Date Deposited: 15 Nov 2017 15:45
Last Modified: 15 Nov 2017 15:45
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1449

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