Přidat názor k článku Kráva, soudruzi a slzy v očích…

Kili, mrzi mne, ze primar cituje protokol chystane studie a neni schopny vyhledat si na Cochrane neco relevantnejsiho, treba tohle:

"Intrapartum antibiotics for Group B streptococcal colonisation
A Plain language summary will be prepared for the update of this review.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Smaill FM. Intrapartum antibiotics for Group B streptococcal colonisation. Cochrane Database of Systematic Reviews 1996, Issue 1. Art. No.: CD000115. DOI: 10.1002/14651858.CD000115.

This version first published online: April 25. 1995


Abstract
Background
Group B streptococcal infection is common in pregnant women without causing harm. However it is also a significant cause of neonatal morbidity and mortality.

Objectives
The objective of this review was to assess the effects of intrapartum administration of antibiotics to women on infant colonization with group B streptococcus, early onset neonatal group B streptococcus sepsis and neonatal death from infection.

Search strategy
The Cochrane Pregnancy and Childbirth Group trials register was searched.

Selection criteria
Controlled trials of pregnant women colonized with group B streptococcus comparing intrapartum antibiotic administration with no treatment, and providing data on infant colonization with group B streptococcus and/or neonatal infection.

Data collection and analysis
Eligibility and trial quality assessment were done by one reviewer.

Main results
Five trials were included. Overall quality was poor, with potential selection bias in all the identified studies. Intrapartum antibiotic treatment reduced the rate of infant colonization (odds ratio 0.10, 95% confidence interval 0.07 to 0.14) and early onset neonatal infection with group B streptococcus (odds ratio 0.17, 95% confidence interval 0.07 to 0.39). A difference in neonatal mortality was not seen (odds ratio 0.12, 95% confidence interval 0.01 to 2.00).

Authors" conclusions
Intrapartum antibiotic treatment of women colonized with group B streptococcus appears to reduce neonatal infection. Effective strategies to detect maternal colonization with group B streptococcus and better data on maternal risk factors for neonatal group B streptococcus infection in different populations are required."

Pises: "Včasná detekce infekce GBS má zásadní význam pro efekt terapie a tak při včasné detekci je tato terapie úspěšná a podíl zemřelých na infekci GBS nízký. Je ovšem rozdíl mezi záchranou života při už vznikilém onemocnění a profylaktické zábraně infekce" - pak jak to vis, kdyz dukazy jsou nedostatecne. Neargumentuj prosim zkusenosti, jak se snizila umrtnost od r. 1970 na priklad. Historicka argumentace je metodicky vadna: porovnavat se musi pristupy pri soucasnych diagnostickych a lecebnych dovednostech.

Muj zcestny a plytky nahled na vec zrejme zdili veskere vyrobce ATB, kteri kladou na srdce nutnost dobrani ATB lecby aby nevznikla prilezitost pro rezistentni kmeny, a zrejme i vetsina vyspelych statu, ve kterych testy na streptokoka v tehotenstvi se neproplaci, a ve pripade testovani (stoji to ca. 10 EUR, takze duvod neni jeho drahota), preventivni lecbu ATB neprovadi z duvodu pouhe kolonizace GBS. Hlavne ze ve Vsetine tomu rozumi dost hluboko, a i presto, ze dukazy zadne nemaji.

Muzes Kili vysvetlit, na co je dobry test, kdyz preventivne ATB podani nebudou, bez objeveni jinych rizikovych faktoru, a veskera mimina budou se sledovat stejne peclive, protoze onemocnet klidne muze i jakekoliv mimino? Klidne i streptokokem, ktery matce zjisteny nebyl? To prece neznamena, ze deti nebudou sledovane mene. Nepovrchne a nejednoduse prosim.

Nevim proc pro MM musi byt zajimavy a dulezity nazor australske porodnicke organizace na nizozemskou studii o bezpecnosti domaciho porodu. Vubec nevim, proc tento nazor je zajimavy a dulezity: pro kohokoliv.