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

Antibiotic Regimen

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

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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 Patient allergic to penicillin?
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Prevent Group B Strep

Antibiotic Regimen Choices

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Does patient have a history of 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 and erythromycin?
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Erythromycin is no longer a recommended drug for intrapartum GBS prophylaxis. Clindamycin and erythromycin susceptibility testing should be performed on prenatal GBS isolates from penicillin-allergic women at high risk for anaphylaxis. If no susceptibility testing is 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 at high risk for anaphylaxis.

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Prevent Group B Strep

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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 delivery.
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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 which formulations of penicillin G 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 delivery

Broader spectrum agents for treatment of intraamniotic infection with a regimen that includes GBS coverage may be needed.
Antibiotics given for latency in the setting of PPROM that include ampicillin 2g 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 delivery
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Penicillin-allergic women who do not have a history of anaphylaxis, severe non IgE-mediated reaction, pruritic rash, urticaria (hives), immediate flushing, hypotension, angioedema, or respiratory distress following administration of a penicillin or a cephalosporin or recurrent reactions, reactions to multiple beta-lactam antibiotics, or positive penicillin allergy test 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.

Broader spectrum agents for treatment of intraamniotic infection with a regimen that includes GBS coverage may be needed.
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.

Broader spectrum agents for treatment of intraamniotic infection with a regimen that includes GBS coverage may be needed.
Clindamycin 900 mg IV every 8 hours until delivery
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Resistance to erythromycin is often but not always associated with clindamycin resistance. If an isolate is resistant to erythromycin, it might have inducible resistance to clindamycin, even if it appears susceptible to clindamycin. If a GBS isolate is susceptible to clindamycin, resistant to erythromycin, and testing for inducible clindamycin resistance has been performed and is negative (no inducible resistance), then clindamycin can be used for GBS intrapartum prophylaxis instead of Vancomycin.

Broader spectrum agents for treatment of intraamniotic infection with a regimen that includes GBS coverage may be needed.
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