Assessing the Effectiveness of Intrapartum Antibiotic Prophylaxis for Prevention of Early-Onset Group B Streptococcal Disease Through Propensity Score Design

• Activity Number: 150
• Type: Invited
• Date/Time: Monday, August 5, 2013 : 10:30 AM to 12:20 PM
• Sponsor: Health Policy Statistics Section
• Author(s): Elizabeth R Zell*+ and Stephanie Schrag and Tarayn Fairlie
• Companies: Centers for Disease Control and Prevention and CDC and CDC
• Keywords: Observational Study ; Propensity Score Design ; Efficacy ; Effectiveness ; infectious diseases

Abstract

Observational data can assist in answering hard questions about disease prevention. Early-onset neonatal group B streptococcal disease (EOGBS) can be prevented by intrapartum antibiotic prophylaxis (IAP). Clinical trials demonstrated efficacy of beta-lactam agents for a narrow population of women. Questions about effectiveness of antibiotic durations < 4 hours, and agents appropriate for penicillin allergic women remain. We applied propensity score design methods to sample survey data on EOGBS cases and over 7000 non-cases from ten US states in 2003-2004, to match infants exposed to IAP with infants who were not exposed. Antibiotic effectiveness was estimated for different antibiotic classes and durations before delivery. Our analysis supports the recommendation that Beta-lactam intrapartum prophylaxis of at least four hours before delivery remains the primary treatment; less than four hours and clindamycin prophylaxis are not as effective in preventing EOGBS.