Debate over group B streptococcal recommendations
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* Vibhuti Shah
* Arne Ohlsson

R.J. Morrow does not specify the way in which there is an apparent mismatch between our recommendations and the information we presented in our report on preventing group B streptococcal (GBS) infection in newborns,1 but in the interests of complete clarity we would like to direct readers to the full technical document, which is available at [www.ctfphc.org/Full\_Text/CTF\_GBS\_TR\_final.pdf](http://www.ctfphc.org/Full\_Text/CTF_GBS_TR_final.pdf). 

In reply to Morrow's comment regarding inconsistency among national guidelines, we can only reply that we followed an evidence-based process to determine the effectiveness of the 3 strategies and found insufficient evidence to recommend for or against strategy C. Other factors that might be used in decision-making include cost, feasibility and patient preferences, and do not factor directly into our recommendations, although we attempt to address them in other parts of our article.

We disagree with Morrow's statement that strategies A and C could be used to treat the same group of women. If strategy C were adopted, all women with at least one risk factor would receive intrapartum prophylaxis. Many of these women would be negative for group B streptococcus and therefore a larger number of women would be exposed to antibiotics than in strategy A. Finally, our recommendation statement only addresses women at or close to term gestation.

Many organisms other than group B streptococcus cause early-onset sepsis. Chorioamnionitis carries a high risk for neonatal infection, and women with this condition should receive appropriate intrapartum treatment regardless of their GBS colonization status. 

Finally, it should be made clear to health care providers and parents that none of these strategies can prevent all cases of early-onset GBS infection. 

**Vibhuti Shah** **Arne Ohlsson** Canadian Task Force on Preventive Health Care London, Ont.

## Reference

1.  1. Prevention of group B streptococcal infection in newborns. Recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2002;166(7):928-30.
    
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