INTRAPARTUM CHEMOPROPHYLAXIS OF PERINATAL GROUP-B STREPTOCOCCAL INFECTIONS - A CRITICAL-REVIEW OF RANDOMIZED CONTROLLED TRIALS

The purpose of this overview was to critically appraise all published randomized, controlled trials evaluating the efficacy of intrapartum c hemoprophylaxis in reducing perinatal group B streptococcal infections . The Oxford Database of Perinatal Trials, Medline, Excerpta Medica, a nd personal files were used for the literature search. By means of pre set inclusion criteria to select relevant articles, two independent re searchers identified nine randomized, controlled trials. Three trials were excluded because of duplicate publication, one because the random ization process was violated, and one because the outcome data were co llected retrospectively. The quality of the methods of the four accept ed trials was poor, and because of basic flaws meta-analyses of trial results were not performed. Results of three studies showed a statisti cally significant reduction in neonatal group B streptococcal coloniza tion rates with intrapartum chemoprophylaxis. Although a trend toward a reduction in proved neonatal infection was reported in three studies , each lacked the power to reach statistical significance. Intrapartum chemoprophylaxis to reduce perinatal group B streptococcal infections is not supported by conclusive evidence from well designed and conduc ted randomized, controlled trials.