Prevent Group B Strep

Antibiotic Regimen

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Prevent Group B Strep

Antibiotic Regimen

Photo: AntibioticAnswer questions about the patient (such as drug allergies)
to see recommended agent and dosage.
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Prevent Group B Strep

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The User acknowledges and agrees that this tool will be used only as a reference aid, and that the information contained in the product is not intended to be (nor should it be used as) a substitute for the exercise of professional judgment.

In view of the possibility of human error or changes in medical science, the User should confirm the information in the product conforms to the current version of the CDC GBS guidelines by checking for guideline updates. This product is provided without warranties of any kind, express or implied, and the authors disclaim any liability, loss, or damage caused by it or its content.

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Prevent Group B Strep

Antibiotic Regimen Choices

Is the patient allergic to penicillin?
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Prevent Group B Strep

Antibiotic Regimen Choices

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Does the patient report any of the following after receiving penicillin or a cephalosporin?
  • A history suggestive of an IgE-mediated event: pruritic rash, urticaria (hives), immediate flushing, hypotension, angioedema, respiratory distress, or anaphylaxis
  • Recurrent reactions, reactions to multiple beta-lactam antibiotics, or positive penicillin allergy test
  • Severe rare delayed-onset cutaneous or systemic reactions, such as eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome, Stevens-Johnson syndrome, or toxic epidermal necrolysis
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Prevent Group B Strep

Antibiotic Regimen Choices

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Is the isolate susceptible to clindamycin?
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Clindamycin susceptibility testing should be performed on prenatal GBS isolates from penicillin-allergic women at high risk for anaphylaxis. Although erythromycin is not recommended for intrapartum GBS prophylaxis, erythromycin susceptibility testing should also be performed on prenatal GBS isolates being tested for clindamycin susceptibility. If susceptibility testing is not performed, or the results are not available at the time of labor, vancomycin is the preferred agent for GBS intrapartum prophylaxis for penicillin-allergic women who are at high risk for an IgE-mediated event such as anaphylaxis or a severe rare delayed reaction.

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Recommended GBS
Prophylaxis Regimen

Penicillin G, 5 million units IV initial dose, then 2.5-3.0 million units every 4 hours until birth.
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Doses ranging from 2.5 to 3.0 million units are acceptable for the doses administered every 4 hours following the initial dose. The choice within that range should be guided by the formulations of penicillin G that are readily available to reduce the need for pharmacies to specially prepare doses.

OR

Ampicillin 2 g IV initial dose, then 1 g IV every 4 hours until birth

If intraamniotic infection (IAI) is present, antibiotics used to treat IAI should include a regimen that is effective for GBS prophylaxis.
Antibiotics given for latency in the setting of PPROM that include ampicillin 2 g intravenously (IV) once, followed by 1g IV every 6 hours for at least 48 hours are adequate for GBS prophylaxis. If other regimens are used, GBS prophylaxis should be initiated in addition.
Cefazolin 2 g IV initial dose, then 1 g IV every 8 hours until birth
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Penicillin-allergic women who do not have a history suggestive of IgE-mediated reaction, (pruritic rash, urticaria (hives), immediate flushing, hypotension, angioedema, or respiratory distress) recurrent reactions to administration of a beta-lactam antibiotic, reactions to multiple beta-lactam antibiotics, positive penicillin allergy test, or a history of rare delayed onset cutaneous or systemic reactions following administration of a penicillin or a cephalosporin should receive cefazolin for GBS intrapartum prophylaxis. This may include individuals with a history of any of the following: nonspecific symptoms unlikely to be allergic (gastrointestinal distress, headaches, yeast vaginitis), nonurticarial maculopapular (morbilliform) rash without systemic symptoms, pruritis without rash, family history of penicillin allergy but no personal history, or patient reports history but has no recollection of symptoms or treatment.

If intraamniotic infection (IAI) is present, antibiotics used to treat IAI should include a regimen that is effective for GBS prophylaxis.
Vancomycin: weight-based dosage of 20 mg/kg every 8 hours. Maximum single dose is 2 g. Minimum infusion time is 1 hour, or 500 mg/30 minutes for a dose >1 g.

If intraamniotic infection (IAI) is present, antibiotics used to treat IAI should include a regimen that is effective for GBS prophylaxis.
Clindamycin 900 mg IV every 8 hours until delivery
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If intraamniotic infection (IAI) is present, antibiotics used to treat IAI should include a regimen that is effective for GBS prophylaxis.
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