Use (and abuse) of antibiotics in perinatal medicine

Introduction: The rational use of antibiotics (ATB) implies that patients receive those adequate for their clinical needs, in correct doses according to their individual conditions, during an adequate period of time, and at the lowest cost for them and their community. The highest rate of ATB abuse occurs during the perinatal period, despite the fact that there is evidence of multiple short- and long-term negative effects. Furthermore, this abuse is associated with increased costs of medical care. Objective: To update and report the evidence on the use, abuse, and adverse effects of ATB in perinatal medicine, and possible measures to prevent them, and thus improve health care outcomes and costs. Methods: A review and analysis was performed from the literature related to the use of ATB in perinatal medicine up to February 2020. Results: ATB abuse in perinatal medicine ranges from 50% to 70%, with even higher rates in some neonatal centres. Adverse effects include death, increased microbial resistance, along with microbiome abnormalities and dysbiosis that lead to serious life-long complications such as infections, allergies, autoimmune disorders, gastrointestinal disorders, arthritis, asthma, obesity, and perhaps cancer. Preventing and reducing the abuse of ATB would lead to better health and to significant savings in the health sector. In only 4 neonatal intensive care units, with 1000 admissions per year, savings are estimated at US$230,000 per year. Conclusion: The need to optimise the use of ATB in perinatal medicine has never been more urgent. (C) 2020 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.