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]

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.

Shown below is a table depicting the choice of empirical medical therapy in neonatal meningitis.

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

Shown below is a table depicting the choice of targeted medical 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.

References

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