Intrapartum antibiotic prophylaxis 1: relative effects of recommended antibiotics on gram-negative pathogens

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 100; no. 3; pp. 534 - 539
• Main Authors: Edwards, Rodney K, Clark, Penny, Sistrom, Christopher L, Duff, Patrick
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2002; The American College of Obstetricians and Gynecologists; Elsevier Science
• Subjects: Adolescent; Adult; Ampicillin - pharmacology; Ampicillin - therapeutic use; Antibacterial agents; Antibiotic Prophylaxis; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance, Microbial; Enterobacteriaceae - drug effects; Enterobacteriaceae - isolation & purification; Escherichia coli - drug effects; Escherichia coli - isolation & purification; Female; Gram-Negative Bacterial Infections - diagnosis; Gram-Negative Bacterial Infections - drug therapy; Humans; Medical sciences; Microbial Sensitivity Tests; Penicillins - pharmacology; Penicillins - therapeutic use; Pharmacology. Drug treatments; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Outcome; Prenatal Care; Prevention and actions; Probability; Public health. Hygiene; Public health. Hygiene-occupational medicine; Specific populations (family, woman, child, elderly...); Treatment Outcome; Human; Chemoprophylaxis; Neonatal; Drug susceptibility test; β-Lactams; Bacteriological investigation; Infection; Prevention; Penicillin derivatives; Microbiological investigation; Ampicillin; Female genital system; Penicillin; Adult; Female; Delivery; Antibacterial agent; Comparative study; Gram negative bacteria
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/S0029-7844(02)02096-3

OBJECTIVE:
To assess whether the antibiotic chosen for intrapartum antibiotic prophylaxis affects the subsequent exposure of the neonate to ampicillin-resistant gram-negative bacteria.
METHODS:
We performed a randomized clinical trial of ampicillin versus penicillin for intrapartum antibiotic prophylaxis. Genital tract cultures for Enterobacteriaceae were obtained at study entry and 8–36 hours postpartum. Organisms were isolated, identified, and tested for ampicillin susceptibility.
RESULTS:
The ampicillin (
n = 175) and penicillin (
n = 177) groups, respectively, did not differ in rates of ampicillin-resistant
Escherichia coli at entry (25% versus 22%,
P = .57) or postpartum (36% versus 38%,
P = .64). Similarly, groups did not differ in rates of ampicillin-resistant Enterobacteriaceae at entry (38% versus 32%,
P = .23) or postpartum (51% versus 55%,
P = .46). However, postpartum culture rates of resistant
Escherichia coli were higher than entry culture rates for both the ampicillin (36% versus 25%,
P = .026) and penicillin (38% versus 22%,
P < .001) groups. Postpartum culture rates of resistant Enterobacteriaceae were also higher than entry culture rates for both the ampicillin (51% versus 38%,
P < .001) and penicillin (55% versus 32%,
P < .001) groups. Results were similar when considering only women who received two or more doses and no additional antibiotics.
CONCLUSION:
Intrapartum antibiotic prophylaxis with either ampicillin or penicillin increases exposure of neonates to ampicillin-resistant Enterobacteriaceae.