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.
Shown below is a table depicting 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 Neonatal Meningitis
Shown below is a table depicting the choice of targeted medical therapy in neonatal meningitis.[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 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 (AI).
- 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).
- 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).
- 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).
- 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.
Chorioamnionitis
The treatment of chorioamnionitis requires the immediate administration of antibiotics until delivery:
- Ampicillin every 6 hours, PLUS
- Gentamicin every 8-24 hours
References
- ↑ 1.0 1.1 1.2 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.
- ↑ Verani J.R., McGee L, and Schrag S.J. Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC, 2010.CDC.gov