***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Neonatal Group B streptococcal infections may not respond to antimicrobial therapy and have been associated with case fatality rates of 50 per cent or greater . We evaluated the effect on colonization and disease rates of a single intramuscular dose of aqueous penicillin G given at birth in a prospect ively controlled study of 18,738 neonates during a 25-month period . The colonization rate in the mothers was 26.6 per cent , with 50 per cent concordance in the untreated infants and 12.2 per cent in the penicillin-treated infants ( P < 0.001 ) . There was a significant decrease in the incidence of disease caused by all penicillin-susceptible organisms in the penicillin group ( 0.64 vs. 2.26 cases per thous and live births , P = 0.005 ) . Disease caused by penicillin-resistant pathogens was increased in the penicillin-treated group during the first year of the study but was unaffected during the second year . Routine administration of parenteral penicillin at birth can not be recommended until the effect on the incidence of disease caused by penicillin-resistant pathogens is fully defined This prospect i ve study was design ed to identify the role of postnatal penicillin prophylaxis in the prevention of neonatal group B streptococcus ( GBS ) infection . We studied 10 998 infants . Of these , 5389 were in the penicillin prophylaxis group ( PP ) and 5609 infants did not receive penicillin prophylaxis ( NPP ) . Infants were allocated to treatment by month of birth , alternating 3‐mo blocks or 2‐mo blocks to the two groups after the first block was r and omly assigned . The use of PP reduced the incidence of clinical sepsis ( 1.7 % PP versus 2.5 % NPP , p<0.01 ) , GBS infection ( 0.4 % PP versus 0.9 % NPP , p < 0.001 ) and deaths from sepsis ( 0.1 % PP versus 0.3 % NPP , p < 0.05 ) . We conclude that the routine use of postnatal penicillin prophylaxis appears to be effective in reducing the incidence of clinical sepsis and death from sepsis in neonates . □ Antimicrobial prophylaxis , group B streptococcus , neonatal The efficacy of a single dose of aqueous penicillin G in preventing neonatal group-B streptococcal infections was demonstrated in a r and omised study conducted over 41 months . 16 082 infant received a single dose of penicillin within one hour of delivery , and 15 976 infants who received tetracycline ophthalmic ointment served as the control group . Group-B streptococcal systemic infections were significantly less common in the penicillin-treated infants ( 0.6 vs 1.7 cases per 100 live birth , p = 0.004 ) . The incidence of infection caused by penicillin-resistant pathogen was insignificantly increased in the penicillin group ( 2.2 vs 1.6 cases per thous and live birth , p = 0.32 ) . this difference was accounted for almost completely by the events of the first 12 months of the study period when , for unexplained reasons , there was a considerable increase in the number of penicillin-resistant infections in the penicillin group ( 3.6 vs 1.4 cases per 1000 live births , p = 0.09 ) . The mortality associated with penicillin-susceptible pathogens was higher in the control group ( 0.1 vs 0.4 per 1000 live births , p = 0.18 ) . However , the mortality associated with penicillin-resistant pathogens was increased in the penicillin ( 0.4 vs 1.0 per 1000 live births , p = 0.06 ) . The combined mortality rates for all pathogens were not significantly different ( 1.1 vs 0.7 per 1000 liver births , p = 0.27 , for the penicillin and control groups , respectively ) and were nearly equivalent when the excess number of deaths associated with penicillin-resistant infections in the penicillin group during the first study year was excluded from analysis . The incidence of gonococcal ophthalmia and conjunctivitis was unaffected by the use of intramuscular penicillin at birth OBJECTIVE Recommendations for the use of antenatal antibiotics in obstetrics have increased in the past few years , especially for prophylaxis against group B streptococci , for prolongation of the latency time in patients with preterm premature rupture of the membranes , and as an adjuvant treatment in preterm labor . Our objective was to determine whether the use of antenatal ampicillin affects the incidence of and resistance of early-onset neonatal sepsis with organisms other than group B streptococci . STUDY DESIGN A prospect i ve cohort study was performed between January 1 , 1991 , and December 31 , 1996 . Every case of blood culture-proven neonatal sepsis was prospect ively surveyed . The type of bacteria isolated , drug resistance , antenatal antibiotic use and treatment indication , gestational age at delivery , and other antenatal and outcome variables were gathered . Early-onset neonatal sepsis was defined as disease onset within 7 days after birth . RESULTS A total of 42 cases of early-onset neonatal sepsis among 29,897 neonates delivered were found during the 6-year period . Of these , 15 cases were due to group B streptococci and 27 were the result of non-group B streptococcal organisms ( 21 gram-negative rods and 6 gram-positive cocci ) . Among the 27 non-group B streptococcal cases , 15 mothers had received antenatal ampicillin and 13 of the 15 bacterial isolates from these neonates ( 87 % ) were resistant to ampicillin , versus only 2 ampicillin-resistant isolates ( 17 % ) among the 12 cases in which no antenatal antibiotics were administered ( P = .0004 ) . Of the 15 mothers who were treated with ampicillin , 13 received more than 1 dose . In evaluating each year of the study , the overall administration of antibiotics to pregnant women in the antenatal period increased from < 10 % in 1991 to 16.9 % in 1996 . The incidence of early-onset neonatal sepsis with group B streptococci decreased during this time , whereas the incidence of early-onset sepsis with non-group B streptococcal organisms , especially Escherichia coli , increased . CONCLUSIONS The increased administration of antenatal ampicillin to pregnant women may be responsible for the increased incidence of early-onset neonatal sepsis with non-group B streptococcal organisms that are resistant to ampicillin . At this time penicillin G , rather than ampicillin , is therefore recommended for prophylaxis against group B streptococci . In addition , future studies are needed to determine whether alternate approaches , such as immunotherapy or vaginal washing , could be of benefit Abstract . Colonization with group B streptococci of the genital tract was studied in 1115 women during the last trimester of pregnancy . 76 or 6.82 % were found to harbour this bacterium . The incidence of contamination was significantly higher among Belgian women than among parturients of Mediterranean origin ( p < 0.001 ) . It was also more frequent in primigravidae ( p<0.05 ) and in the poorer ( 0.10 < p > 0.05 ) . At the time of admission in the delivery room , it was noticed that rupture of the amniotic membranes for more than 24 hours was more often associated with group B streptococcal carriage by the mother ( p<0.001 ) . 29 out of 68 ( 42.6 % ) infants born to group B streptococci positive mothers were colonized at birth . 67 of them were su bmi tted to a controlled trial of immediate versus delayed penicillin therapy . 44.8 % and 42.1 % of the neonates were contaminated at birth in each group of treatment respectively . No instance of group B streptococcal infection developed in either group . This suggests that immediate therapy with penicillin of infants of group B streptococci positive mothers has no definite advantage upon delayed treatment This document reflects emerging clinical and scientific advances on the date issued and is subject to change . The information should not be construed as dictating an exclusive course of treatment or procedure to be followed . Local institutions can dictate amendments to these opinions . They should be well documented if modified at the local level . None of these contents may be reproduced in any form without prior written permission of the SOGC . This Clinical Practice Guideline has been prepared by the Infectious Disease Committee , review ed by the Infectious Diseases and Immunization and the Fetus and Newborn Committees of the Canadian Paediatric Society , and the SOGC Family Practice Advisory Committee , and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada . We studied the effect of penicillin on early-onset Group B streptococcal disease over a 52-month period in neonates who were at high risk of infection . Shortly after birth , 1187 neonates weighing 2000 g or less had blood sample s taken for cultures and were r and omized into an early-treatment group ( given intramuscular penicillin G within 60 minutes of birth ) or a control group . The incidence of early-onset disease was 20 per 1000 live births ( 24 of 1187 ) ; the number of infants in the early-treatment group who had disease ( 10 of 589 ) was similar to that in the control group ( 14 of 598 ) . The fatality rates were similar in both groups ( 6 of 10 vs. 8 of 14 ) . Cultures from blood obtained with one hour of birth were positive in 21 of the 24 infants with disease ; 22 of the 24 were symptomatic within four hours of birth . Thus , infection was well established before the first hour of postnatal life . At autopsy , gram-positive cocci were seen in lung sections of four infants in whom cultures of blood obtained after treatment had been sterile ; this indicates that giving routine antibiotic therapy before culture sample s are obtained can obscure bacteriologic diagnosis . We conclude that penicillin given at birth to neonates weighing 2000 g or less does not prevent early-onset streptococcal disease or reduce excess mortality associated with disease Objective To determine the effect of single-dose penicillin given at birth on the rate of  early-onset group B streptococcal ( GBS ) invasive disease in an inner-city population . Methods Laboratory-based surveillance of GBS disease from 1972–1994 at Parkl and Memorial Hospital and Children 's Medical Center in Dallas , Texas , was review ed retrospectively . All infants born at Parkl and Memorial Hospital from January 1 , 1972 to December 31 , 1994 , or a total of 259,049 live births , were included .  Early-onset ( within 3 days ) GBS disease rates were compared for each of five observation groups to determine the efficacy of a single dose of aqueous penicillin G ( 50,000 U for infants weighing 2000 g or more and 25,000 U for those weighing less than 2000 g ) administered intramuscularly within 1 hour of delivery for prevention of GBS disease . Results The rates of early-onset GBS disease were compared in five observation groups : A ) pre- study , January 1 , 1972 to December 3 , 1977—no GBS prophylaxis ; B ) prospect i ve , controlled intervention study , December 4 , 1977 to May 31 , 1981 , including infants who received a single dose of penicillin at birth ( group B1 ) and those who did not ( group B2 ) ; C ) universal penicillin prophylaxis , June 1 , 1981 to October 31 , 1986 ; and D ) no routine penicillin prophylaxis , November 1 , 1986 to December 31 , 1994 . The incidence of early-onset GBS disease in the penicillin groups ( B1 , C ) was significantly lower than that in the untreated groups ( A , B2 , D ) : 0.25 and 0.63 per 1000 versus 1.59 , 1.19 , and 1.95 per 1000 , respectively ( P ≤ .03 ) . The incidence of late-onset GBS disease was unaffected by penicillin prophylaxis , and there was no increase in the incidence of disease caused by penicillin-resistant pathogens or associated mortality in penicillin-treated infants : 2.2 and 2.1 per 1000 versus 1.6 and 3.3 per 1000 for disease ; 1.0 and 0.5 per 1000 versus 0.4 and 0.3 per 1000 for deaths . Conclusion Universal administration of single-dose pencillin at birth is a safe and effective intervention for the prevention of early-onset GBS 
    Output:
    
REVIEW ERS ' CONCLUSIONS This review does not support the routine use of intramuscular penicillin to prevent EOGBSD in newborn infants .