Against a backdrop of a global crisis in antibiotic resistance, Dr Alison Bedford Russell said that antibiotics should only be given for a very clear reason, in the appropriate dose and for as short a time as possible. Resistance is everyone’s problem. Giving mothers antibiotics because they might have something was simply not good enough in this era. There were other tools, PCR for example, as well as culture-based methods as alternatives. We needed to get a lot cleverer at this.
Proof Neena Modi felt that everyone should be able to agree that “the current guidance is inconsistent and that doesn’t serve families well at all.” But it was important to recognise, too, that “a consensus-based guideline, in other words, a guideline that is not based on good evidence, is a really serious patient safety issue.”
We have got to be very, very very careful about using antibiotics unnecessarily. However, antibiotics are and can be life saving and they are life saving in infection – in established infection and they can be life saving for babies when the mother is at risk of transmitting group B Strep. So, for me it’s all about judicious use.
Dr Alison Bedford Russell, Consultant Neonatologist, Medical Director Birmingham Women’s NHSFT
At the present time, the risk factor approach seems to be resulting in lots of women getting antibiotics which in fact are not necessary because the woman is not a group B strep carrier, and a lot of women who are carriers whose babies end up getting early onset are not getting it and actually those two are relatively balanced; the numbers are quite similar so it seems to us to be a bit more sensible to be giving it targeted in women that we know are carriers while we are waiting for the vaccines to be developed.
Prof Philip Steer, Emeritus professor of obstetrics at Imperial College, editor emeritus of BJOG
One firm conclusion that I hope we can all agree with: the current guidance is inconsistent. It also, I think, leaves us with the position that there’s a great danger in actually imposing something that may well be harmful and therefore, for me, it seems that the self-evident conclusion that we have to draw, we have to reach is that we really must stop trying to draw up guidelines on the basis of inadequate evidence but instead put all of this passion, energy, effort and well-meant determination to improve things for our patients towards actually addressing the science, doing the studies and getting a sensible outcome. And if we have collaborated to do this 5, 10, 15 years ago; we would now have the answer. So I would like to say that, on behalf of the Royal College of Paediatrics and Child Health, I’m very, very happy to work with my colleagues in the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists to actually advocate and lobby in order to secure the funding to do the sorts of trials that we need to do.
Prof Neena Modi, President, Royal College of Paediatrics & Child Health
