Prophylaxis for early onset group B streptococcal sepsis is not so effective in practice

Editor—Oddie and Embleton highlight the dangers of and risk factors for early onset group B streptococcal sepsis.¹ They analysed their data retrospectively and estimate that most cases (78%) could have received effective antenatal or intrapartum prophylaxis but accept that this interpretation might be an overestimate.

This maternity unit recently introduced a protocol for selective intrapartum prophylaxis against group B streptococcal infection on the basis of recognised clinical risk factors and subsequently audited our practice with respect to whether eligible women received adequate prophylaxis or not.² Over an initial four week period 37 (10.3%) of 359 women were eligible for antibiotic prophylaxis, but only 12 (32%) of those eligible received adequate prophylaxis. After minor changes to the protocol and staff education, a re-audit over a subsequent four week period identified 49 (13%) of 378 women eligible with 20 (42%) of those eligible receiving adequate prophylaxis.³ This represents but a modest improvement.

This audit represents clinical practice in a teaching hospital delivery suite. When guidelines for prophylaxis against group B streptococci are being designed, the difference between that which might be achieved (78%¹) and that which is achieved (32% to 42%³) needs to be recognised.