Group B streptococcal infection medical therapy: Difference between revisions

Jump to navigation Jump to search
m (Changes made per Mahshid's request)
 
(20 intermediate revisions by one other user not shown)
Line 4: Line 4:


==Overview==
==Overview==
Group B streptococcal (GBS) infection should be suspected as a causative agent for bacterial meningitis in infants less than two years of age, among whom empirical antibiotic therapy should be initiated immediately.<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref>  [[Ampicillin]] or [[penicillin]] are recommended for the treatment of confirmed neonatal GBS [[meningitis]].<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref>  Intrapartum antibiotic treatment should be administered to asymptomatic pregnant women who are carriers of GBS because it provides prophylaxis against the transmission of the infection to the neonate.  [[Penicillin]] remains the agent of choice for intrapartum antibiotic prophylaxis, with [[ampicillin]] as an acceptable alternative.<ref name=CDCMMWR>Verani J.R., McGee L, and Schrag S.J. Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC, 2010.[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w CDC.gov]</ref>  [[Penicillin]] and [[ampicillin]] are generally effective for the treatment of GBS infection in non-pregnant adults.<ref name="pmid11462195">{{cite journal| author=Farley MM| title=Group B streptococcal disease in nonpregnant adults. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 4 | pages= 556-61 | pmid=11462195 | doi=10.1086/322696 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11462195  }} </ref>


==Medical Therapy in Neonatal Meningitis==
==Medical Therapy in Neonatal Meningitis==
===Empirical Antibiotic Therapy in Neonatal Meningitis===
===Empirical Antibiotic Therapy in Neonatal Meningitis===
GBS should be suspected as a causative agent for bacterial meningitis in infants less than two years of age for whom empirical antibiotic therapy should be initiated immediately.
Group B streptococcal (GBS) infection should be suspected as a causative agent for bacterial meningitis in infants less than two years of age, among whom empirical antibiotic therapy should be initiated immediately according to the Infectious Diseases Society of America (IDSA) guidelines.<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref>


Shown below is a table depicting the choice of empirical medical therapy in neonatal meningitis.<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref>
Shown below is a table summarizing the choice of empirical medical therapy in neonatal meningitis.<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref>


{| style="cellpadding=0; cellspacing= 0; width: 800px;"
{| style="cellpadding=0; cellspacing= 0; width: 800px;"
Line 32: Line 33:
|}
|}


===Targeted Antibiotic Therapy in Neonatal Meningitis===
===Targeted Antibiotic Therapy in GBS Neonatal Meningitis===
Shown below is a table depicting the choice of targeted medical therapy in neonatal meningitis.<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref>
Shown below is a table summarizing the choice of targeted medical therapy in neonatal meningitis according to the IDSA guidelines.<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref>


{| style="cellpadding=0; cellspacing= 0; width: 800px;"
{| style="cellpadding=0; cellspacing= 0; width: 800px;"
Line 110: Line 111:
* Positive GBS vaginal-rectal screening culture in late gestation during current pregnancy
* Positive GBS vaginal-rectal screening culture in late gestation during current pregnancy


Intrapartum antibiotic treatment of asymptomatic pregnant women who are carriers of GBS because it provides prophylaxis against the transmission of the infection to the newborn.
Intrapartum antibiotic treatment of asymptomatic pregnant women who are carriers of GBS is recommended because it provides prophylaxis against the transmission of the infection to the newborn.


Intrapartum antibiotic prophylaxis is not indicated in this circumstance if a cesarean delivery is performed before onset of labor on a woman with intact amniotic membranes.
Intrapartum antibiotic prophylaxis is not indicated in this circumstance if a cesarean delivery is performed before onset of labor on a woman with intact amniotic membranes.
Line 116: Line 117:
The following are key components of intrapartum antibiotic prophylaxis agents and dosing:<ref name=CDCMMWR>Verani J.R., McGee L, and Schrag S.J. Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC, 2010.[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w CDC.gov]</ref>
The following are key components of intrapartum antibiotic prophylaxis agents and dosing:<ref name=CDCMMWR>Verani J.R., McGee L, and Schrag S.J. Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC, 2010.[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w CDC.gov]</ref>


* [[Penicillin]] remains the agent of choice for intrapartum antibiotic prophylaxis, with ampicillin as an acceptable alternative (AI).
* [[Penicillin]] remains the agent of choice for intrapartum antibiotic prophylaxis, with [[ampicillin]] as an acceptable alternative (class A, level of evidence I).


* Penicillin-allergic women who do not have a history of [[anaphylaxis]], [[angioedema]], [[respiratory distress]], or [[urticaria]] following administration of a [[penicillin]] or a [[cephalosporin]] should receive [[cefazolin]] (BII).
* Penicillin-allergic women who do not have a history of [[anaphylaxis]], [[angioedema]], [[respiratory distress]], or [[urticaria]] following administration of a [[penicillin]] or a [[cephalosporin]] should receive [[cefazolin]] (class B, level of evidence II).


* Antimicrobial susceptibility testing should be ordered for antenatal GBS cultures performed on [[penicillin]]-allergic women at high risk for [[anaphylaxis]] because of a history of [[anaphylaxis]], [[angioedema]], [[respiratory distress]], or [[urticaria]] following administration of a [[penicillin]] or a [[cephalosporin]] (AII). To ensure proper testing, clinicians must inform laboratories of the need for antimicrobial susceptibility testing in such cases (AIII).
* Antimicrobial susceptibility testing should be ordered for antenatal GBS cultures performed on [[penicillin]]-allergic women at high risk for [[anaphylaxis]] because of a history of [[anaphylaxis]], [[angioedema]], [[respiratory distress]], or [[urticaria]] following administration of a [[penicillin]] or a [[cephalosporin]] (AII). To ensure proper testing, clinicians must inform laboratories of the need for antimicrobial susceptibility testing in such cases (class A, level of evidence III).


* Penicillin-allergic women at high risk for [[anaphylaxis]] should receive [[clindamycin]] if their GBS isolate is susceptible to [[clindamycin]] and [[erythromycin]], as determined by antimicrobial susceptibility testing; if the isolate is sensitive to [[clindamycin]] but resistant to [[erythromycin]], [[clindamycin]] may be used if testing for inducible [[clindamycin]] resistance is negative (CIII). Penicillin-allergic women at high risk for [[anaphylaxis]] should receive [[vancomycin]] if their isolate is intrinsically resistant to [[clindamycin]] as determined by antimicrobial susceptibility testing, if the isolate demonstrates inducible resistance to [[clindamycin]], or if susceptibility to both agents is unknown (CIII).
* Penicillin-allergic women at high risk for [[anaphylaxis]] should receive [[clindamycin]] if their GBS isolate is susceptible to [[clindamycin]] and [[erythromycin]], as determined by antimicrobial susceptibility testing; if the isolate is sensitive to [[clindamycin]] but resistant to [[erythromycin]], [[clindamycin]] may be used if testing for inducible [[clindamycin]] resistance is negative (CIII). Penicillin-allergic women at high risk for [[anaphylaxis]] should receive [[vancomycin]] if their isolate is intrinsically resistant to [[clindamycin]] as determined by antimicrobial susceptibility testing, if the isolate demonstrates inducible resistance to [[clindamycin]], or if susceptibility to both agents is unknown (class C, level of evidence III).


* The recommended dosing regimen of [[penicillin G]] is 5 million units intravenously, followed by 2.5--3.0 million units intravenously every 4 hours (AII). The range of 2.5--3.0 million units is recommended to achieve adequate drug levels in the fetal circulation and amniotic fluid while avoiding [[neurotoxicity]]. The choice of dose within that range should be guided by which formulations of [[penicillin G]] are readily available in order to reduce the need for pharmacies to specially prepare doses.
* The recommended dosing regimen of [[penicillin G]] is 5 million units intravenously, followed by 2.5--3.0 million units intravenously every 4 hours (class A, level of evidence II). The range of 2.5--3.0 million units is recommended to achieve adequate drug levels in the fetal circulation and amniotic fluid while avoiding [[neurotoxicity]]. The choice of dose within that range should be guided by which formulations of [[penicillin G]] are readily available in order to reduce the need for pharmacies to specially prepare doses.
 
Shown below is an algorithm depicting the choice of antibiotics for the primary prevention of early-onset GBS neonatal infection based on the 2010 revised CDC guidelines.<ref name=CDCMMWR>Verani J.R., McGee L, and Schrag S.J. Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC, 2010.[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w CDC.gov]</ref>
{{Family tree/start}}
{{Family tree | | | A01 | | | A01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Is the patient allergic to penicillin?''' </div>}}
{{Family tree | |,|-|^|-|.| | }}
{{Family tree | B01 | | B02 | B01= No| B02= Yes}}
{{Family tree | |!| | | |!| | }}
{{Family tree | C01 | | C02 | C01= <div style="float: left; text-align: left; width: 20em; padding:1em;">[[Penicillin G]], 5 million units IV initial dose, <br> then 2.5-3.0 million units every 4 hours until delivery<br><br> OR<br> <br> [[Ampicillin]], 2 g IV initial dose, <br> then 1 g IV every 8 hours until delivery </div>| C02= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Does the patient a history of any of the following after receiving penicillin or cephalosporin?''' <br> [[Anaphylaxis]] <br> [[Angioedema]] <br> [[Respiratory distress]] <br> [[Urticaria]] </div>}}
{{Family tree | | | |,|-|^|-|.| | }}
{{Family tree | | | D01 | | D02 | D01= No| D02= Yes}}
{{Family tree | | | |!| | | |!| | }}
{{Family tree | | | E01 | | E02 | E01= <div style="float: left; text-align: left; width: 20em; padding:1em;">[[Cefazolin]], 2 g IV initial dose, <br> then 1 g IV every 8 hours until delivery </div>| E02= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Is the isolate susceptible to [[clindamycin]] and [[erythromycin]]?''' </div>}}
{{Family tree | | | | |,|-|-|^|.| | }}
{{Family tree | | | | F01 | | F02 | F01= No| F02= Yes}}
{{Family tree | | | | |!| | | |!| | }}
{{Family tree | | | | G01 | | G02 | G01= <div style="float: left; text-align: left; width: 20em; padding:1em;">[[Vancomycin]], 1 g IV every 12 hours until delivery </div>| G02= <div style="float: left; text-align: left; width: 20em; padding:1em;">[[Clindamycin]], 900 mg IV every 8 hours until delivery </div>}}
{{Family tree/end}}


===Chorioamnionitis===
===Chorioamnionitis===
The treatment of [[chorioamnionitis]] requires the immediate administration of antibiotics until delivery.  In addition, antipyretics must be administered.
The treatment of [[chorioamnionitis]] requires the immediate administration of broad spectrum antibiotics until delivery.  In addition, antipyretics must be administered.<ref name="pmid20569811">{{cite journal| author=Tita AT, Andrews WW| title=Diagnosis and management of clinical chorioamnionitis. | journal=Clin Perinatol | year= 2010 | volume= 37 | issue= 2 | pages= 339-54 | pmid=20569811 | doi=10.1016/j.clp.2010.02.003 | pmc=PMC3008318 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20569811  }} </ref>
 
The broad spectrum antibiotics regimen, particularly among pregnant women who were administered prophylactic intrapartum penicillin G for GBS, includes:<ref name="pmid20569811">{{cite journal| author=Tita AT, Andrews WW| title=Diagnosis and management of clinical chorioamnionitis. | journal=Clin Perinatol | year= 2010 | volume= 37 | issue= 2 | pages= 339-54 | pmid=20569811 | doi=10.1016/j.clp.2010.02.003 | pmc=PMC3008318 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20569811  }} </ref>
* [[Ampicillin]] 2 g every 6 hours, PLUS
* [[Gentamicin]] 1.5 mg/kg every 8-24 hours
 
If the patient is undergoing C-section, the following antibiotics must be added to the initial broad spectrum antibiotics to cover for [[anaerobe]]s:
* [[Clindamycin]] 900 mg IV, OR
* [[Metronidazole]] 500 mg IV<ref name="pmid15495005">{{cite journal| author=French LM, Smaill FM| title=Antibiotic regimens for endometritis after delivery. | journal=Cochrane Database Syst Rev | year= 2004 | volume=  | issue= 4 | pages= CD001067 | pmid=15495005 | doi=10.1002/14651858.CD001067.pub2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15495005  }} </ref>
 
==Medical Therapy in Adults==
[[Penicillin]] and [[ampicillin]] are generally effective for the treatment of GBS infection in non pregnant adults; however, it is best that the antibiotic treatment is guided by the susceptibility testing results.  The duration of antibiotic therapy should be a minimum of 2 weeks but longer duration of treatment should be attempted in fulminant infections.<ref name="pmid11462195">{{cite journal| author=Farley MM| title=Group B streptococcal disease in nonpregnant adults. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 4 | pages= 556-61 | pmid=11462195 | doi=10.1086/322696 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11462195  }} </ref>


The antibiotics regimen is:
[[Gentamicin]] might be considered as an addition to the initial antibiotic regimens.<ref name="pmid11462195">{{cite journal| author=Farley MM| title=Group B streptococcal disease in nonpregnant adults. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 4 | pages= 556-61 | pmid=11462195 | doi=10.1086/322696 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11462195  }} </ref>
* [[Ampicillin]] every 6 hours, PLUS
 
* [[Gentamicin]] every 8-24 hours
The dose of antibiotics might be higher than that in other types of infection, particularly in [[meningitis]].<ref name="pmid11462195">{{cite journal| author=Farley MM| title=Group B streptococcal disease in nonpregnant adults. | journal=Clin Infect Dis | year= 2001 | volume= 33 | issue= 4 | pages= 556-61 | pmid=11462195 | doi=10.1086/322696 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11462195  }} </ref>


==References==
==References==
Line 140: Line 169:
[[Category:Streptococcaceae]]
[[Category:Streptococcaceae]]
[[Category:Obstetrics]]
[[Category:Obstetrics]]
[[Category:Infectious disease]]
 
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[Category:Pediatrics]]
[[Category:Neonatology]]


{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}

Latest revision as of 17:51, 18 September 2017

Group B Streptococcal Infection Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Group B Streptococcal Infection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Treatment

Medical Therapy

Primary Prevention

Secondary Prevention

Future or Investigational Therapies

Case Studies

Case #1

Group B streptococcal infection medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Group B streptococcal infection medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Group B streptococcal infection medical therapy

CDC on Group B streptococcal infection medical therapy

Group B streptococcal infection medical therapy in the news

Blogs on Group B streptococcal infection medical therapy

Directions to Hospitals Treating Group B streptococcal infection

Risk calculators and risk factors for Group B streptococcal infection medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Overview

Group B streptococcal (GBS) infection should be suspected as a causative agent for bacterial meningitis in infants less than two years of age, among whom empirical antibiotic therapy should be initiated immediately.[1] Ampicillin or penicillin are recommended for the treatment of confirmed neonatal GBS meningitis.[1] Intrapartum antibiotic treatment should be administered to asymptomatic pregnant women who are carriers of GBS because it provides prophylaxis against the transmission of the infection to the neonate. Penicillin remains the agent of choice for intrapartum antibiotic prophylaxis, with ampicillin as an acceptable alternative.[2] Penicillin and ampicillin are generally effective for the treatment of GBS infection in non-pregnant adults.[3]

Medical Therapy in Neonatal Meningitis

Empirical Antibiotic Therapy in Neonatal Meningitis

Group B streptococcal (GBS) infection should be suspected as a causative agent for bacterial meningitis in infants less than two years of age, among whom empirical antibiotic therapy should be initiated immediately according to the Infectious Diseases Society of America (IDSA) guidelines.[1]

Shown below is a table summarizing the choice of empirical medical therapy in neonatal meningitis.[1]

Age Possible pathogens causing the bacterial meningitis Empirical treatment
< 1 month Ampicillin + cefotaxime
OR
Ampicillin + aminoglycoside
1-23 months Vancomycin + third generation cephalosporin

Targeted Antibiotic Therapy in GBS Neonatal Meningitis

Shown below is a table summarizing the choice of targeted medical therapy in neonatal meningitis according to the IDSA guidelines.[1]

Recommended therapy for GBS meningitis Alternative therapy for GBS meningitis
Ampicillin
OR
Penicillin
Consider adding an aminoglycoside
Third generation cephalosporin
(Ceftriaxone or cefotaxime)

Recommended Dosage of Antibiotics

Shown below is a table summarizing the recommended dosage of antibiotics according to the IDSA guidelines.[1]

Antibiotic agent Dosage
Amikacin 0-7 days: 15-20 mg/kg

8-28 days: 30 mg/kg


Infants > 28 days: 20-30 mg/kg

Ampicillin 0-7 days: 150 mg/kg

8-28 days: 200 mg/kg


Infants > 28 days: 300 mg/kg

Cefotaxime 0-7 days: 100-150 mg/kg

8-28 days: 150-200 mg/kg


Infants > 28 days: 225-300 mg/kg

Ceftazidime 0-7 days: 100-150 mg/kg

8-28 days: 150 mg/kg


Infants > 28 days: 150 mg/kg

Ceftriaxone Infants > 28 days: 80-100 mg/kg
Gentamicin 0-7 days: 5 mg/kg

8-28 days: 7.5 mg/kg


Infants > 28 days: 7.5 mg/kg

Penicillin G 0-7 days: 0.15 mg/kg

8-28 days: 0.2 mg/kg


Infants > 28 days: 0.3 mg/kg

Tobramycin 0-7 days: 5 mg/kg

8-28 days: 7.5 mg/kg


Infants > 28 days: 7.5 mg/kg

Vancomycin 0-7 days: 20-30 mg/kg

8-28 days: 30-45 mg/kg


Infants > 28 days: 60 mg/kg

Consider lower dosages and longer intervals of antibiotics in case of very low-birth weight neonates.

Medical Therapy for Pregnant Women

Asymptomatic Carriers

Treatment for GBS is indicated in cases of:

  • GBS bacteriuria during any trimester of the current pregnancy
  • Positive GBS vaginal-rectal screening culture in late gestation during current pregnancy

Intrapartum antibiotic treatment of asymptomatic pregnant women who are carriers of GBS is recommended because it provides prophylaxis against the transmission of the infection to the newborn.

Intrapartum antibiotic prophylaxis is not indicated in this circumstance if a cesarean delivery is performed before onset of labor on a woman with intact amniotic membranes.

The following are key components of intrapartum antibiotic prophylaxis agents and dosing:[2]

  • Penicillin remains the agent of choice for intrapartum antibiotic prophylaxis, with ampicillin as an acceptable alternative (class A, level of evidence I).
  • Penicillin-allergic women at high risk for anaphylaxis should receive clindamycin if their GBS isolate is susceptible to clindamycin and erythromycin, as determined by antimicrobial susceptibility testing; if the isolate is sensitive to clindamycin but resistant to erythromycin, clindamycin may be used if testing for inducible clindamycin resistance is negative (CIII). Penicillin-allergic women at high risk for anaphylaxis should receive vancomycin if their isolate is intrinsically resistant to clindamycin as determined by antimicrobial susceptibility testing, if the isolate demonstrates inducible resistance to clindamycin, or if susceptibility to both agents is unknown (class C, level of evidence III).
  • The recommended dosing regimen of penicillin G is 5 million units intravenously, followed by 2.5--3.0 million units intravenously every 4 hours (class A, level of evidence II). The range of 2.5--3.0 million units is recommended to achieve adequate drug levels in the fetal circulation and amniotic fluid while avoiding neurotoxicity. The choice of dose within that range should be guided by which formulations of penicillin G are readily available in order to reduce the need for pharmacies to specially prepare doses.

Shown below is an algorithm depicting the choice of antibiotics for the primary prevention of early-onset GBS neonatal infection based on the 2010 revised CDC guidelines.[2]

 
 
Is the patient allergic to penicillin?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
Penicillin G, 5 million units IV initial dose,
then 2.5-3.0 million units every 4 hours until delivery

OR

Ampicillin, 2 g IV initial dose,
then 1 g IV every 8 hours until delivery
 
Does the patient a history of any of the following after receiving penicillin or cephalosporin?
Anaphylaxis
Angioedema
Respiratory distress
Urticaria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Cefazolin, 2 g IV initial dose,
then 1 g IV every 8 hours until delivery
 
Is the isolate susceptible to clindamycin and erythromycin?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Vancomycin, 1 g IV every 12 hours until delivery
 
Clindamycin, 900 mg IV every 8 hours until delivery

Chorioamnionitis

The treatment of chorioamnionitis requires the immediate administration of broad spectrum antibiotics until delivery. In addition, antipyretics must be administered.[4]

The broad spectrum antibiotics regimen, particularly among pregnant women who were administered prophylactic intrapartum penicillin G for GBS, includes:[4]

If the patient is undergoing C-section, the following antibiotics must be added to the initial broad spectrum antibiotics to cover for anaerobes:

Medical Therapy in Adults

Penicillin and ampicillin are generally effective for the treatment of GBS infection in non pregnant adults; however, it is best that the antibiotic treatment is guided by the susceptibility testing results. The duration of antibiotic therapy should be a minimum of 2 weeks but longer duration of treatment should be attempted in fulminant infections.[3]

Gentamicin might be considered as an addition to the initial antibiotic regimens.[3]

The dose of antibiotics might be higher than that in other types of infection, particularly in meningitis.[3]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
  2. 2.0 2.1 2.2 Verani J.R., McGee L, and Schrag S.J. Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC, 2010.CDC.gov
  3. 3.0 3.1 3.2 3.3 Farley MM (2001). "Group B streptococcal disease in nonpregnant adults". Clin Infect Dis. 33 (4): 556–61. doi:10.1086/322696. PMID 11462195.
  4. 4.0 4.1 Tita AT, Andrews WW (2010). "Diagnosis and management of clinical chorioamnionitis". Clin Perinatol. 37 (2): 339–54. doi:10.1016/j.clp.2010.02.003. PMC 3008318. PMID 20569811.
  5. French LM, Smaill FM (2004). "Antibiotic regimens for endometritis after delivery". Cochrane Database Syst Rev (4): CD001067. doi:10.1002/14651858.CD001067.pub2. PMID 15495005.

Template:Bacterial diseases


Template:WikiDoc Sources