Antimicrobial prophylaxis to prevent infection is an appealing concept. This approach is used for clinical scenarios in which the benefits have been clearly established, such as the prevention of surgical site infections, group B Streptococcus (GBS) sepsis in the neonate, and congenital and acquired immune deficiencies. In each case, the potential benefits of prophylaxis, including infection-associated morbidity and even mortality, must be weighed against the known risks of antimicrobial resistance and adverse drug effects. Ideally, only the highest risk patients are targeted for prophylaxis to avoid unnecessary exposure (eg, laboring mothers who are GBS positive or clean-contaminated surgical procedures) and the risk/benefit assessment is periodically reassessed over time as new data emerge.

Postpartum infections of the mother and newborn are critically important targets of preventive health efforts. Approximately 1 million neonates die each year from infection; 99% of the deaths occur in developing countries.1 Because GBS is a major...

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