NumberResearch recommendation
Intrapartum antibiotics
RR 5What is the clinical and cost effectiveness of intrapartum antibiotic prophylaxis using benzylpenicillin in women with preterm labour?

Why this is important
In the absence of unequivocal evidence of clinical and cost effectiveness of intrapartum antibiotic prophylaxis to prevent early-onset neonatal infection in the babies of all women with preterm labour, the recommendation to consider intrapartum antibiotic prophylaxis for women with preterm labour and either prelabour rupture of membranes or confirmed or suspected rupture of membranes of 18 hours’ duration or longer was based on the Guideline Development Group’s consensus view and knowledge of current practice.
Further research is needed to evaluate the clinical and cost effectiveness of intrapartum antibiotic prophylaxis using benzylpenicillin compared with placebo in women with preterm labour (including women with intact membranes and those with ruptured membranes). The research should be conducted through multicentre randomised controlled trials, including some UK centres to allow subgroup analysis of UK data. The primary outcome for evaluating the clinical effectiveness of benzylpenicillin should be the incidence of early-onset neonatal group B streptococcal infection (infection within 72 hours of birth). Secondary outcomes should include long-term outcomes in the baby. The research should include subgroup analyses for women in spontaneous preterm labour with intact membranes and those with membranes that rupture before or during labour.
RR 6What is the optimal dosage regimen for benzylpenicillin when used as intrapartum antibiotic prophylaxis to prevent early-onset neonatal infection?

Why this is important
The systematic reviews conducted for the guideline identified limited evidence relating to the optimal dosage regimen for benzylpenicillin when used as intrapartum antibiotic prophylaxis to prevent early-onset neonatal infection. Further research is needed to determine the optimal dosage regimens of benzylpenicillin according to the gestational age of the developing baby. The research should include studies involving population pharmacokinetic modelling and studies that relate pharmacokinetic parameters to clinical and microbiological outcomes. The research should also consider the clinical and cost effectiveness of oral and intravenous routes of administration.

From: 6, Intrapartum antibiotics

Cover of Antibiotics for Early-Onset Neonatal Infection
Antibiotics for Early-Onset Neonatal Infection: Antibiotics for the Prevention and Treatment of Early-Onset Neonatal Infection.
NICE Clinical Guidelines, No. 149.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Aug.
Copyright © 2012, National Collaborating Centre for Women’s and Children’s Health.

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