I think we should move to a single, screening-based guideline. We should routinely screen every pregnant woman with cultures for GBS and give intrapartum chemoprophylaxis to all carriers. There's also a higher incidence of disease in mothers younger than 20 years of age. The disadvantage is that it was never submitted for clinical trial until it was recommended. The other major disadvantage is that you have to have a risk factor before a physician knows to give prophylaxis.
Some risks are easy to identify and there's lots of time for planning.
If you go into premature labor, that's easy too. But one of the causes of premature labor might be GBS, so by the time labor starts, infection is already beginning. It's a timing issue. We know efficacy relates to the number of doses of antibiotics or the amount of time prophylaxis is given before delivery. The screening-based approach doesn't exclude any women, and it includes women who don't have a risk factor but who carry the organism, said Baker, who noted if a woman doesn't show signs of risk, the only way to detect GBS is a positive culture.