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Group B Streptococcal Disease, Early-onset (Green-top Guideline No. 36)

Published: 18/07/2012

This is the second edition of this guideline. The first edition was published in 2003 under the same title.


Update December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app will remain valid until replaced.


Group B streptococcus (Streptococcus agalactiae) is recognised as the most frequent cause of severe early-onset (at less than 7 days of age) infection in newborn infants. However, there is still controversy about its prevention. Surveys in 2001 and 2008 demonstrated that less than 1% of UK maternity units were performing systematic screening for GBS and, to date, UK clinicians have not generally adopted the US and Canadian practice of routine screening for GBS carriage.

Extrapolation of practice from the USA to the UK may, however, be inappropriate. The incidence of EOGBS disease in the UK in the absence of systematic screening or widespread intrapartum antibiotic prophylaxis (IAP) is 0.5/1000 births, which is similar to that seen in the USA after universal screening and IAP, despite comparable vaginal carriage rates. The incidence of culture-confirmed early-onset disease in the USA has fallen in association with the introduction of screening pregnant women for GBS.

The purpose of this guideline is to provide guidance for obstetricians, midwives and neonatologists on the prevention of early-onset neonatal group B streptococcal (EOGBS) disease. Prevention of late-onset GBS and treatment of established GBS disease is not considered beyond initial antibiotic therapy.