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Neonatal antibiotic prophylaxis for the prevention of early- and late-onset Group B streptococcal sepsis

Sir, We read with interest the article by Bertini et al. on prevention of earlyand late-onset Group B streptococcal sepsis (GBS) w2x. In their study, early-onset GBS infection decreased from 0.5‰ at baseline period to 0.19‰ at the study period, and late-onset GBS disease decreased from 0.74‰ to 0.048‰. However, the interpretation of the results needs further discussion. First, during the second period of their study (1997–2002) in which a ten-day course of oral amoxicillin (50 mg/kg bid) was administered to all colonized infants, the authors found a significantly lower rate of late-onset neonatal Group B streptococcal sepsis than during the baseline period (1990–1996). Eradication of colonizing bacteria could be a fundamental tool for the reduction of the risk of late-onset bacterial sepsis. However, a number of studies since the mid-1970s have shown that antibiotic treatment is ineffective in the eradication of bacterial colonization w1, 5, 8x. The authors obtained surface culture samples from the external ear canal of each newborn at birth, but not after treatment, thus not demonstrating any effect of antibiotics on colonization. It follows that the reduction of the late-onset Group B streptococcal sepsis rate during the study period could be attributed to factors other than the antibiotic course, such as the reduction of the colonization rate at birth during the same years. Indeed, the authors report the