 |
|
 |
|
 |
 |
|
 |
 |
 |
 |
 |
 |
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
To the Editor.—
We read with interest the article by Glasgow et al.1 The authors sought to determine the effects of intrapartum antibiotic prophylaxis (to prevent early-onset neonatal infections with group B streptococci) on late-onset serious bacterial infections in term infants. The authors conclude from their data that penicillin should be used preferentially over ampicillin for intrapartum antibiotic prophylaxis, because the use of more broad-spectrum agents results in a greater likelihood that the neonate will be colonized by more virulent, antibiotic-resistant bacteria.
Although we previously would have intuitively suspected this assertion to be correct, we believe that such a conclusion is unjustified, given the data presented in the article. Only 23 women in their study actually received penicillin, and barely >60 received any intrapartum antibiotics. Also, the authors cite but do not compare their data to that from our clinical trial, in which >350 women were randomly assigned to receive penicillin or ampicillin and underwent lower–genital tract cultures before and after antibiotic exposure. Surprisingly, in our study both penicillin and ampicillin were associated equally with an increase in the proportion of women with ampicillin-resistant Gram-negative organisms recovered from the lower genital tract, which is one of the primary sources from which neonatal bacterial flora are derived. Because our level 1 data contradict the causal relationship that the authors conclude from their case-control study, it seems that they should have directly considered why their data and conclusions differed from ours.
Furthermore, the term "serious" does not accurately describe the majority of infections reported in this study. Almost three fourths of the infected infants in the study actually had urinary tract infections without bacteremia, which are relatively mild infections compared with sepsis or meningitis.
We agree with Glasgow et al that eventual immunization against group B streptococci would be preferable to the current strategy of intrapartum antibiotic prophylaxis. We also share their concern that such antibiotic use may have unintended consequences. However, we believe that, until antibiotic prophylaxis is no longer needed, decisions about which antibiotic to choose should be based on the best available evidence rather than theoretical and lower-level evidence.
REFERENCES
Related articles in Pediatrics:
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
||
|
||
Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2006 American Academy of Pediatrics. All rights reserved. |
||
|
||
