Universal antenatal screening for group B streptococcus may cause more harm than good

Abstract

Based on current evidence, routine screening for group B streptococcus colonisation in late pregnancy should not be introduced in the UK, as the potential harms of unnecessary treatment with antibiotics may outweigh the benefits, argue Farah Seedat and colleagues

Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

“…However, the evidence we found is derived from observational data in an inherently heterogeneous set of studies with possible bias. Although the estimation of possible harm by antibiotic overtreatment by Seedat et al is relevant, the conclusions need to be verified by clinical data . We have to resign ourselves to the fact that an overtreatment may occur with both strategies.…”

“…Schrag et al 44 constructed a model with assumptions of perfect adherence in which screening outperformed the risk-based protocols, suggesting the presence of an inherent advantage of screening protocols possibly owing to their limited complexity. Importantly, concerns have been raised recently by Seedat et al 21 that universal screening may lead to overtreatment with the consequent increase in adverse effects and resistance to antibiotics. Our findings do not support the concern that universal screening results in antibiotic overtreatment.…”

“…Although the estimation of possible harm by antibiotic overtreatment by Seedat et al is relevant, the conclusions need to be verified by clinical data. 21 We have to resign ourselves to the fact that an overtreatment may occur with both strategies. In this meta-analysis, the overall exposure to antibiotics does not appear to differ greatly between the two protocols, whereas the rates of EOGBS disease do.…”

“…No international consensus on the best protocol currently exists and a future strategy is under debate. 21 As no randomised studies on the topic have been carried out, policy-making remains a challenge.…”

Authors’ reply re: Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset Group B streptococcal disease: a systematic review and meta‐analysis

“…Their clarifications on the UK National Screening Committee (UK NSC) position are very clear. The UK NSC decided against a general screening because they cannot assess the benefits and harms in the patient populations of women; 3 but they could in newborns. The ongoing clinical trial (GBS3 Trial; ISRCTN49639731) in the UK will compare the current risk‐based strategy with two different screening tests.…”