Seedat, Farah, Stinton, Chris, Patterson, Joseph P., Geppert, Julia, Tan, Bee K., Robinson, Esther R., McCarthy, Noel D., Uthman, Olalekan A., Freeman, Karoline, Johnson, Samantha Ann, Fraser, Hannah, Brown, Colin Stewart, 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. doi:10.1186/s12884-017-1432-3 ISSN 1471-2393.

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Abstract

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.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.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.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.CRD42016037195 .

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Journal or Publication Title:	BMC Pregnancy and Childbirth
Publisher:	BioMed Central Ltd.
ISSN:	1471-2393
Official Date:	26 July 2017
Dates:	Date Event 26 July 2017 Published
Volume:	17
Number:	1
Number of Pages:	14
Page Range:	p. 247
DOI:	10.1186/s12884-017-1432-3
Status:	Peer Reviewed
Publication Status:	Published
Reuse Statement (publisher, data, author rights):	** From Europe PMC via Jisc Publications Router. ** Licence for this article: cc by
Access rights to Published version:	Open Access (Creative Commons)
Open Access Version:	Other Other

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