Whether and how to treat Group B Strep: the continuing gulf between evidence and practice…

small__5987537049Some readers of this blog and my facebook page will already be aware that I am spending my Summer writing a new book for AIMS about group B strep (GBS), so the timing of the updated Cochrane review on Intrapartum antibiotics for known maternal Group B streptococcal colonization couldn’t have been better for me. But even though the conclusions of this review remain unchanged (principally because of the lack of good evidence in this area), or perhaps because the conclusions of this review remain unchanged, I wanted to write a quick post on this as a reminder of the state of play.

As I discussed in this article, which was a review of the last update of the Cochrane review on GBS,

“This area of practice is a controversial one. As the reviewers note, the pressure to implement some kind of prophylaxis came from parents and the media, and it is easy to understand how the experience of losing a baby could lead to a desire to do something in order to prevent others from having the same experience. Unfortunately, there is no way of preventing all cases of GBS disease, there is a lack of evidence of effectiveness of intrapartum antibiotic prophylaxis and there are significant ramifications of continuing to recommend this to large numbers of women. While there exist a number of examples of maternity care in which practice does not correlate with the evidence, the fact that the reviewers see further research as being limited because of the current guidelines in place in many areas makes this situation particularly extreme. The combination of the pressure to ‘do’ something in an attempt to prevent tragedy and the perceived difficulty of going against entrenched guidelines – whether or not they are evidence-based – would appear to have led to a situation where we may be doing more harm than good, without any means of working out if and how we could do better.” (Wickham 2010: 30)

I am currently reviewing the literature for this project and am focusing on writing a book that will explain the issues, offer clear explanations of the different perspectives and approaches, look at what we do and do not know and, I hope, provide a foundation which will help parents make the decision that is right for them. As I wade through the several hundred papers that have been published in this area in recent years, though, it is striking me that the vast majority of them are not robust research which would help move our knowledge forward, but reiterations of current policy and practice.  I find it even more striking that our ability to undertake the trials that would enable us to gain a better understanding of this area is limited by the entrenched nature of that practice…

 

Wickham S (2010). Antibiotics for Group B Strep: are they effective? Essentially MIDIRS 1(1): 27-30.

photo credit: josemanuelerre via photopin cc

1 comment for “Whether and how to treat Group B Strep: the continuing gulf between evidence and practice…

  1. July 3, 2014 at 6:48 pm

    Thank you. Proof that information has limits and common medical practice is not infallible. Moms deserve an actual choice. I tried to refuse the GBS test during pregnancy because I had already had two healthy babies before testing was widespread and was very desperate for a gentle birth with no unnecessary needles, hep lock/IV, or other painful interruptions. I was threatened and coerced. I was told if I refused antibiotics my baby would get a spinal tap. I had to refuse penicillin due to allergy (the nurse midwife was willing to risk a reaction because my allergy had caused “just a rash” when I was little) so I got clindamycin which is 22% effective against GBS at best (CDC estimate) and carries a very high risk of secondary infection because it’s so effective at wiping out good bacteria. My poor baby was given a blood culture and 2 penicillin shots without my permission increasing her risk of death by up to 40% (Royal College of Obstetrics and Gynecology estimate). I got horrific thrush and struggled with breastfeeding. I went on to breastfeed for 2 years but it was a horrific painful struggle. It hurt between feedings. All for no reason and against my will. Neither me or my baby ever had a fever or any other hints of any infection.

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