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How great is the risk from antibiotics?
The recommended antibiotic for treating GBS during labor is penicillin. Fewer bacteria currently show a resistance to penicillin than to other antibiotics used to treat GBS. The options are fewer for women known to be allergic to penicillin. Up to 29 percent of GBS strains have been shown to be resistant to non-penicillin antibiotics.46 For women not known to be allergic to penicillin, there is a one in ten risk of a mild allergic reaction to penicillin, such as a rash. Even for those women who have no prior experience of a penicillin allergy, there is a one in 10,000 chance of developing anaphylaxis, a life-threatening allergic reaction.
We can compare this to CDC estimates that 0.5 percent of babies born to GBS-positive mothers with no treatment will develop a GBS infection, and that 6 percent of those who develop a GBS infection will die. Six percent of 0.5 percent means that three out of every 10,000 babies born to GBS-positive mothers given no antibiotics during labor will die from GBS infection. If the mother develops anaphylaxis during labor (one in 10,000 will), and it is untreated, it is likely that the infant, too, will die. So, by CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor.
It should be noted that antibiotics such as penicillin kill GBS as well as other bacteria that might cause a newborn to become ill. Currently, the use of penicillin during labor may be a case in which the benefits outweigh the risks, depending on your individual risk factors for passing GBS on to your baby. However, it was only a few years ago that the same could have been said about other antibiotics. Ampicillin and amoxicillin have been rendered virtually useless for treating GBS by their prior overuse in laboring women in an effort to prevent GBS infection in newborns. How long will it be before penicillin, too, becomes useless in the battle to prevent GBS infections?
More minor risks of the use of antibiotics include an increase in thrush and other yeast infections among newborns. Along with the risks of thrush and allergic reactions, women must take into consideration the risk of creating antibiotic-resistant bacteria in themselves and their newborns. It is possible that exposure to antibiotics during birth could delay establishment of healthy bacteria in the infant's intestinal tract and allow penicillin-resistant bacteria, many of which are harmful, to become established.
Each woman must weigh for herself the likelihood of GBS infection in her newborn, taking into account her individual risk factors as well as the risk of other forms of infection caused by antibiotic-resistant bacteria. This is a good discussion to have with your healthcare provider so that you can be an informed partner in your own health care.
Alternatives to Antibiotics
Many women are interested in alternatives to antibiotics that may help get rid of GBS prior to labor. Unfortunately, no scientific studies of alternative treatments have been published. Several researchers have suggested that studies are needed to determine whether alternative approaches to eradicating GBS in pregnant women would be effective. Alternate approaches that have been suggested include vaginal washing and immunotherapy.47 At this point, however, these alternatives remain to be studied, and I am aware of no healthcare providers that use either method.
Some practitioners of natural medicine have suggested supplements for the mother in an effort to eradicate GBS prior to delivery. One suggestion is that, when a woman tests positive for GBS, she should take a course of garlic, vitamin C, echinacea, and/or bee propolis, and then be re-tested to determine if she is still carrying GBS. Any supplements that a pregnant woman considers taking should first be discussed with a homeopathic or naturopathic physician or other knowledgeable practitioner of natural medicine.
Because colonization by GBS is intermittent or transient for 60 percent of carriers, testing positive for GBS once does not indicate that a woman will always be colonized.48 However, most studies indicate that a positive culture at 35 to 37 weeks gestation is a fairly accurate predictor of GBS colonization at delivery. Without an active effort to eradicate the GBS colonization, it is likely that a woman will still be colonized at delivery.
Ultimately, it is the pregnant woman herself who will have to decide what is right for her and her baby. Deciding to follow the recommendations of ACOG and the CDC is not necessarily the wrong choice, as long as a woman is adequately informed of the risks that come with antibiotic use. But none of us should blindly follow recommendations to interfere with the natural birth process without taking a good look at the risks, as well as the benefits, of doing so.