I thank Dr Berardi et al for their interest in my article; their comments provide an opportunity to elaborate on several aspects of this opinion. I agree with their observation that modifying intrapartum management strategies to optimize exposure to antibiotic prophylaxis for group B Streptococcus (GBS) will result in the mother-infant dyad being potentially treated with a longer course of antibiotic therapy. As obstetricians, we are faced with the unique situation of simultaneously treating 2 patients while balancing the risk vs benefit of a remedy and thus attempting to achieve an efficacious equilibrium to both.

The recent publication by Dr Berardi et al of 458 neonates did show no statistical differences in rates of neonatal colonization with GBS with the duration of antibiotic exposure. As they state, neonatal colonization is a poor marker of infection. However, their report also observed that 41% of these infants received inadequate intrapartum antibiotic prophylaxis (ie, <4 hours). The 2 cohort studies that correlated the duration of GBS prophylaxis with clinical outcomes (with >12,000 mother-infant pairs between them) suggest that 4 hours of antibiotic therapy is needed for maximum advantage to reduce the risk of early-onset GBS disease.

Although we should all strive to limit exposure to unnecessary antibiotic therapy, when evidence suggests that an effective level of antibiotic contact provides an utmost benefit, one should endeavor for that goal. Unfortunately, to achieve an accuracy of administering at least 4 hours of intrapartum antibiotic treatment for GBS prophylaxis, this may result in sacrificing some precision in dispensing those medications.