Intrapartum antibiotic prophylaxis for women who are screened positive for group B streptococcal colonisation: Clinical compliance with the guideline

Aust N Z J Obstet Gynaecol. 2021 Dec;61(6):870-875. doi: 10.1111/ajo.13370. Epub 2021 May 13.


Background: In high income countries, ~30% of pregnant women are provided with intrapartum antibiotic prophylaxis (IAP) for early-onset group B streptococcal infection (EOGBSI). The infection rate is low, 0.2/1000 livebirths in our jurisdiction, and others. We hypothesised factors, other than IAP alone, were reasons for the low rate of EOGBSI.

Aims: Compliance with our local guideline, referred to here as 'the guideline'.

Method: Compliance was defined as an initial dose of benzylpenicillin IAP followed by four-hourly doses until birth. The study population was drawn from 4098 women who had 4100 pregnancies resulting in 4200 babies in an Australian birth setting from 1/1/2016 to 31/12/2016. Most, 93%, were eligible for universal GBS screening, 67% were reported as screened and 90% of these had a result documented; 23% were positive for GBS. A random sample (n = 223) was taken for further analysis.

Results: The adjusted odds of receiving benzylpenicillin IAP in accord with the guideline were three times higher among primiparous compared to multiparous women (P < 0.001, odds ratio (OR) = 3.4, 95% CI 1.7-6.7) and three times higher among women experiencing induction of labour compared to women who commenced labour spontaneously (P < 0.001, OR = 3.4, 95% CI 1.8-6.3). Of the 223 women, 188 received IAP: 176 received benzylpenicillin IAP, 31% (or 24% of the total sample) received this intervention in accord with the guideline, 24% received benzylpenicillin ≥4 h before birth but not in accord with the guideline and 44% received benzylpenicillin <4 h before birth.

Conclusion: We conclude that sub-optimal compliance was largely a consequence of an unrealistic guideline.

Keywords: group B strep*; intrapartum antibiotic prophylaxis; neonatal infection; screen*; sepsis.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Antibiotic Prophylaxis
  • Australia
  • Female
  • Humans
  • Infectious Disease Transmission, Vertical
  • Pregnancy
  • Pregnancy Complications, Infectious* / drug therapy
  • Pregnancy Complications, Infectious* / prevention & control
  • Streptococcal Infections* / diagnosis
  • Streptococcal Infections* / drug therapy
  • Streptococcal Infections* / prevention & control
  • Streptococcus agalactiae


  • Anti-Bacterial Agents