A systematic review of Perinatal Antibiotic Stewardship - where we are, where to go?

The perinatal period is associated with high antibiotic exposure, which raises concerns about antimicrobial resistance (AMR) and future health impacts. The aim of this comprehensive systematic review, including publications from 2000 to 2022, is to describe the current evidence and state of antimicrobial stewardship (AMS) in the perinatal period and to identify gaps in knowledge for future research. The review included 36 studies from the Americas, Europe, Asia and Australia, involving a total of 64,798 pregnant women and 84,137 newborns. 33 out of 36 studies reported reduced antibiotic use, suggesting the potential to reduce antibiotic exposure. There is a lack of studies in the antepartum and intrapartum periods, of comprehensive AMS strategies across the entire perinatal period, and from low- and middle-income countries with a high burden of maternal and neonatal morbidity and mortality. Future research should include prospective, adequately powered studies including safety endpoints, clinical outcomes and AMR reports.