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Effect of intrapartum antibiotics on the intestinal microbiota of infants: a systematic review
  1. Petra Zimmermann1,2,3,4,
  2. Nigel Curtis2,3,4
  1. 1 Department of Paediatrics, Fribourg Hospital HFR and Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
  2. 2 Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  3. 3 Infectious Diseases Unit, The Royal Children’s Hospital Melbourne, Parkville, Victoria, Australia
  4. 4 Infectious Diseases Research Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Dr Petra Zimmermann, Department of Paediatrics, Faculty of Science and Medicine, University of Fribourg, CH-1700 Fribourg, Switzerland; petra.zimmermann{at}


Introduction The use of intrapartum antibiotic prophylaxis (IAP) has become common practice in obstetric medicine and is used in up to 40% of deliveries. Despite its benefits, the risks associated with exposing large numbers of infants to antibiotics, especially long-term effects on health through changes in the microbiota, remain unclear. This systematic review summarises studies that have investigated the effect of IAP on the intestinal microbiota of infants.

Methods A systematic search in Ovid MEDLINE was used to identify original studies that investigated the effect of IAP on the intestinal microbiota in infants. Studies were excluded if: they included preterm infants, the antibiotic regimen was not specified, antibiotics were used for indications other than prophylaxis, probiotics were given to mothers or infants, or antibiotics were given to infants.

Results We identified six studies, which investigated a total of 272 infants and included 502 stool samples collected up to 3 months of age. In all the studies, IAP was given for group B streptococcus (GBS) colonisation. Infants who were exposed to GBS IAP had a lower bacterial diversity, a lower relative abundance of Actinobacteria, especially Bifidobacteriaceae, and a larger relative abundance of Proteobacteria in their intestinal microbiota compared with non-exposed infants. Conflicting results were reported for the phyla Bacteroidetes and Firmicutes.

Conclusions GBS IAP has profound effects on the intestinal microbiota of infants by diminishing beneficial commensals. Such changes during the early-life ‘critical window’ during which the intestinal microbiota and the immune response develop concurrently may have an important influence on immune development. The potential long-term adverse consequences of this on the health of children warrant further investigation.

  • neonate
  • delivery
  • microbiome
  • 16srna
  • prophylaxis

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  • Contributors PZ drafted the initial manuscript. NC critically revised the manuscript and both authors approved the final manuscript as submitted.

  • Funding PZ is supported by a Fellowship from EPSID and an International Research Scholarship from the University of Melbourne.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice The article type has been changed to Original article since this paper was published Online First.

  • Patient consent for publication Not required.