Group B streptococcal infection medical therapy

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

Overview

Medical 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.

Age Possible pathogens causing the bacterial meningitis Empirical treatment
< 1 month Streptococcus agalactiae
Escherichia coli
Listeria monocytogenes
Klebsiella
Ampicillin + cefotaxime
OR
Ampicillin + aminoglycoside
1-23 months Streptococcus pneumoniae
Neisseria meningitidis
Streptococcus agalactiae
Haemophilus influenzae
E. coli
Vancomycin + third generation cephalosporin

Targeted Antibiotic Therapy in Neonatal Meningitis

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.

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.

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