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Canadian Task Force on Preventive Health Care

Recommendation Table

Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

Preventive Health Care, 2001 Update: Prevention of Early-onset Group B Streptococcal (GBS) Infection in the Newborn

Prepared by V. Shah, MD, MRCP, and A. Ohlsson, MD, MSc, FRCPC, FAAP, with the Canadian Task Force on Preventive Health Care

These recommendations were finalized by the Task Force in February 2001.

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF> RECOMMENDATION

Universal screening* of pregnant women for GBS colonization and selective intrapartum chemoprophylaxis (IPC)** to colonized women with risk factors*** Clinical effectiveness is proven for reduction in neonatal colonization and early onset neonatal disease.
Associated with low level of antibiotic use.

Dependent on compliance with screening and availability of adequate laboratory resources.

Use of penicillin may lead to selection of antibiotic resistant bacteria and increases the risk of allergic reactions in women.

Not effective for women who do not receive prenatal care.
Small cohort studies (II-1, II-2), <Morales, 1987; Pylipow, 1994; Gibbs, 1994) The CTFPHC concludes that there is fair evidence to recommend this strategy in reducing neonatal colonization and early onset neonatal disease (B).
Most efficient strategy based on number needed to treat.

Universal screening* of pregnant women for GBS colonization and IPC** to all colonized women. Clinical effectiveness is proven for reduction in neonatal colonization and early onset neonatal disease.
Associated with high level of antibiotic use.

Dependent on compliance with screening and availability of adequate laboratory resources.

Increased use of penicillin may lead to selection of antibiotic resistant bacteria and increases the risk of allergic reactions in women.

Not effective for women who do not receive prenatal care.
Cohort studies (II-2), <Allardice, 1982; Garland, 1991> The CTFPHC concludes that there is fair evidence to recommend this strategy in reducing neonatal colonization and early onset neonatal disease (B).

IPC** based on risk factors only. The effectiveness of a risk factors based strategy has not been evaluated. Insufficient evidence available. The CTFPHC concludes that there is insufficient evidence to recommend for or against risk factor based strategy to reduce early onset neonatal disease (C).

*Collection of antenatal cultures (swab from lower vagina and rectum) should occur at 35-37 weeks gestation. Swabs should be inoculated into selective broth medium, followed by overnight incubation and then subcultured onto solid blood agar medium.

**Currently adequate IPC consists of at least one dose of intravenous penicillin (5 million units) given at least 4 hours prior to birth. If labour continues beyond 4 hours penicillin should be administered every 4 hours until delivery (CDC, 1996). Clindamycin 900 mg IV every 8 hours or erythromycin 500 mg every 6 hours until delivery are recommended for women allergic to penicillin (CDC, 1996).

***Risk factors include 1) preterm labor (< 37 weeks gestation), 2) prolonged rupture of membranes > 18 hours, 3) maternal fever > 38.0^oC, 4) group B streptococcus bacteriuria during pregnancy, and 5) previous delivery of a newborn with group B streptococcus disease regardless of current group B streptococcus colonization.

Cautionary note: The emerging resistance to erythromycin and clindamycin among GBS strains is of concern.

Link to Published Recommendation Statement

Link to Full Technical Report (in pdf)

Link to Structured Abstract of this review

Link to Selected References list of this review

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MANEUVER	EFFECTIVENESS	LEVEL OF EVIDENCE <REF>	RECOMMENDATION
Universal screening* of pregnant women for GBS colonization and selective intrapartum chemoprophylaxis (IPC) to colonized women with risk factors*	Clinical effectiveness is proven for reduction in neonatal colonization and early onset neonatal disease. Associated with low level of antibiotic use. Dependent on compliance with screening and availability of adequate laboratory resources. Use of penicillin may lead to selection of antibiotic resistant bacteria and increases the risk of allergic reactions in women. Not effective for women who do not receive prenatal care.	Small cohort studies (II-1, II-2), <Morales, 1987; Pylipow, 1994; Gibbs, 1994)	The CTFPHC concludes that there is fair evidence to recommend this strategy in reducing neonatal colonization and early onset neonatal disease (B). *Most efficient strategy based on number needed to treat.*
Universal screening* of pregnant women for GBS colonization and IPC** to all colonized women.	Clinical effectiveness is proven for reduction in neonatal colonization and early onset neonatal disease. Associated with high level of antibiotic use. Dependent on compliance with screening and availability of adequate laboratory resources. Increased use of penicillin may lead to selection of antibiotic resistant bacteria and increases the risk of allergic reactions in women. Not effective for women who do not receive prenatal care.	Cohort studies (II-2), <Allardice, 1982; Garland, 1991>	The CTFPHC concludes that there is fair evidence to recommend this strategy in reducing neonatal colonization and early onset neonatal disease (B).
IPC** based on risk factors only.	The effectiveness of a risk factors based strategy has not been evaluated.	Insufficient evidence available.	The CTFPHC concludes that there is insufficient evidence to recommend for or against risk factor based strategy to reduce early onset neonatal disease (C).