Background: Adverse outcomes from IAP are essential to inform clinical practice for neonatal group B Streptococcus (GBS) prevention, yet they are poorly documented. This review synthesised evidence on adverse outcomes in the mother and/or her child after IAP.
Methods: Medline, Embase, Cochrane, and Science Citation Index were searched from inception to October 16th 2016. Reference lists of relevant studies were hand-searched. Primary studies in English that reported any adverse outcomes from intrapartum antibiotics for any prophylactic purpose compared to controls were included. The search was not restricted to GBS prophylaxis but excluded symptomatic women and caesarean sections. Two reviewers independently conducted study selection, data extraction, and quality assessment. Results were narratively synthesised in text and tables.
Results: 30 studies were included from 2,364 records. A wide range of adverse outcomes were reported in 17 observational studies and 13 randomised controlled trials (RCTs). However, the evidence was at high risk of bias and inconsistent. One RCT investigated the long-term outcomes of IAP reporting serious outcomes such as cerebral palsy; however, it had uncertain biological plausibility and limited applicability. In seven observational studies, IAP for GBS colonisation altered infant microbiota. However, study populations were not followed to clinical outcomes, thus clinical significance is unknown. Finally, observational evidence showed increased antimicrobial resistance, however studies were at risk of bias.
Conclusions: The evidence base to quantify adverse outcomes from IAP for neonatal GBS prevention is limited. Better-quality and longitudinal observational studies across countries with widespread IAP are needed, as RCTs might not be feasible.