Antepartum vaginal administration of chloramphenicol for prevention of early-onset neonatal group B streptococcal

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  • 新生児B群溶血性連鎖球菌感染予防のための，妊娠中のクロラムフェニコール腟錠投与の試み
  • シンセイジ Bグン ヨウケツセイ レンサ キュウキン カンセン ヨボウ ノ タメ ノ,ニンシン チュウ ノ クロラムフェニコールチツジョウ トウヨ ノ ココロミ

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Abstract

Intrapartum antibiotic prophylaxis (IAP) has reduced the incidence of early-onset group B streptococcus (GBS) infection in neonates, but the risk of antibiotic-resistant bacteria infection in the future is a cause for concern. To examine the possibility of decreasing the number of pregnant women with IAP responsive for resistant bacteria, we attempted local eradication of bacteria in pregnant women who tested positive for GBS from the 34th through the 37th weeks of pregnancy, by using chloramphenicol (CP) vaginal tablets. We also investigated the influence of the GBS carriage rate, rate of GBS transmission to newborns, time required between IAP and delivery, and time required between rupture of membrane and delivery for GBS transmission to newborns. On screening 982 pregnant women from the 34th through the 37th weeks of pregnancy, 139 (14.2%) were found to be GBS positive. Although 20 out of the 98 pregnant women (20.4%) who were given CP vaginal tablets became GBS negative, 3 out of the 11 pregnant women (27.3%) who were not treated with CP vaginal tablets also became GBS negative; thus, the CP vaginal tablets were not found to be very efficacious against the local eradication of bacteria. Seventeen of the 149 pregnant women (11.4%) with positive GBS cultures at the time of delivery had newborns whose cultures were positive for GBS. Of these women, 12 had been treated with IAP; however, the time between IAP and delivery for all of them, except one, was less than 4 hours. The time from membrane rupture to delivery was not associated with the rate of GBS transmission to newborns. During the current study, no cases of early-onset neonatal GBS infections were noted. The findings indicate that it is important to consider reexamination in the case of pregnant women when there is a period of more than four weeks after the initial culture and delivery and develop approaches to ensure a sufficient time interval between IAP and delivery. [Adv Obstet Gynecol, 65(2) : 119- 125, 2013 (H25.5)]

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