Prevention and risk reduction | Neonatal infection: antibiotics for prevention and treatment | Guidance

1.6 When to offer antibiotics during labour to prevent early-onset neonatal infection

1.6.1

Offer antibiotics during labour to women, trans men and non-binary people who:

are in pre-term labour or
have group B streptococcal colonisation, bacteriuria or infection during the current pregnancy or
have had group B streptococcal colonisation, bacteriuria or infection in a previous pregnancy, and have not had a negative test for group B streptococcus by enrichment culture or polymerase chain reaction (PCR) on a rectovaginal swab samples collected between 35 and 37 weeks' gestation or 3 to 5 weeks before the anticipated delivery date in the current pregnancy or
have had a previous baby with an invasive group B streptococcal infection or
have a clinical diagnosis of chorioamnionitis. [2021]

1.6.2

Use table 1 on intrapartum antibiotics to decide which antibiotic to use when giving intrapartum antibiotics for neonatal infection. [2021]

**Table 1: Intrapartum antibiotics**
Allergies	Women, trans men and non-binary people without chorioamnionitis	Women, trans men and non-binary people with chorioamnionitis
No penicillin allergy	Use benzylpenicillin sodium.	Use benzylpenicillin sodium plus gentamicin plus metronidazole.
Penicillin allergy that is not severe	Use cephalosporin with activity against group B streptococcus (for example, cefotaxime). Use with caution. In April 2021 this was an off-label use of cephalosporins. See NICE's information on prescribing medicines.	Use cephalosporin with activity against group B streptococcus (for example, cefotaxime) plus metronidazole. Use with caution. In April 2021 this was an off-label use of cephalosporins. See NICE's information on prescribing medicines.
Severe penicillin allergy	Consider: Vancomycin or An alternative antibiotic that would be expected to be active against group B streptococcus based on either sensitivity testing performed on the woman's, trans man's or non-binary person's isolate or on local antibiotic susceptibility surveillance data. In April 2021 this was an off-label use of vancomycin. See NICE's information on prescribing medicines.	Consider: Vancomycin plus gentamicin plus metronidazole or An alternative antibiotic to vancomycin that would be expected to be active against group B streptococcus based on either sensitivity testing performed on the woman's, trans man's or non-binary person's isolate or on local antibiotic susceptibility surveillance data plus gentamicin plus metronidazole. In April 2021 this was an off-label use of vancomycin. See NICE's information on prescribing medicines.

1.6.3

If using intravenous gentamicin during labour, use once-daily dosing. [2021]

1.6.4

Give the first dose of antibiotics as soon as possible after labour starts (or as soon as infection is suspected, in the case of chorioamnionitis), and continue until the birth of the baby. [2021]

1.6.5

Be aware that therapeutic drug monitoring may be needed when using gentamicin or vancomycin during labour. [2021]

For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on when to offer antibiotics during labour to prevent early-onset neonatal infection.

Full details of the evidence and the committee's discussion are in evidence review B: intrapartum antibiotic prophylaxis for reducing early-onset neonatal infection.

1.7 When to offer immediate birth to prevent early-onset neonatal infection

1.7.1

Offer an immediate birth (by induction of labour or caesarean birth) to women, trans men and non-binary people who are between 34 and 37 weeks' gestation who:

have prolonged prelabour rupture of membranes and
have group B streptococcal colonisation, bacteriuria or infection at any time in their current pregnancy. [2021]

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on when to offer immediate birth to prevent early-onset neonatal infection.

Full details of the evidence and the committee's discussion are in evidence review C: timing of delivery to reduce the risk of early-onset neonatal infection.

1.8 Use of rifampicin-miconazole-impregnated catheters in babies for reducing risk of late-onset neonatal infection

1.8.1

Do not use rifampicin-miconazole-impregnated catheters for newborn babies. [2021]

For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on antimicrobial-impregnated catheters for reducing risk of late-onset neonatal infection.

Full details of the evidence and the committee's discussion are in evidence review F: antibiotic-impregnated catheters for reducing late-onset neonatal infection.