Choroba paciorkowcowa grupy b
Leczenie

Choroba paciorkowcowa grupy B (GBS) wymaga precyzyjnego doboru antybiotykoterapii zależnie od wieku pacjenta, typu infekcji oraz stanu klinicznego. Penicylina G pozostaje lekiem pierwszego wyboru zarówno u dorosłych, jak i noworodków, z dawkowaniem u niemowląt do 7 dnia życia w zakresie 250 000-450 000 j./kg/dobę, a powyżej 7 dnia życia 450 000-500 000 j./kg/dobę. W przypadku alergii na penicylinę stosuje się klindamycynę, erytromycynę, fluorochinolony lub wankomycynę, przy czym klindamycyna wymaga potwierdzenia wrażliwości ze względu na narastającą oporność. Czas trwania terapii jest uzależniony od lokalizacji zakażenia: 10 dni dla bakteriemii i zakażeń skóry, minimum 14 dni dla zapalenia opon mózgowo-rdzeniowych, a 3-4 tygodnie lub dłużej dla zapalenia kości, szpiku, wsierdzia i komór mózgu. Leczenie noworodków z podejrzeniem posocznicy obejmuje ampicylinę i aminoglikozyd (najczęściej gentamycynę), a po potwierdzeniu GBS i poprawie klinicznej kontynuuje się monoterapię penicyliną G.

  1. Leczenie choroby paciorkowcowej grupy b
    1. Antybiotykoterapia jako podstawa leczenia
    2. Leczenie zakażeń GBS u noworodków
    3. Czas trwania antybiotykoterapii w różnych zakażeniach GBS
    4. Postępowanie w przypadku zapalenia opon mózgowo-rdzeniowych wywołanego GBS
    5. Profilaktyka antybiotykowa śródporodowa
    6. Postępowanie w przypadku alergii na penicylinę
    7. Postępowanie w przypadku nawrotów zakażenia GBS
    8. Leczenie chirurgiczne w zakażeniach GBS
    9. Rola konsultacji specjalistycznych
    10. Leczenie GBS u kobiet w ciąży
  2. Profilaktyka zakażeń GBS u noworodków
    1. Wskazania do profilaktyki antybiotykowej śródporodowej
    2. Antybiotyki stosowane w profilaktyce śródporodowej
    3. Moment rozpoczęcia profilaktyki antybiotykowej
    4. Interwencje położnicze a profilaktyka antybiotykowa
    5. Postępowanie w przypadku przedwczesnego porodu
    6. Szczególne sytuacje kliniczne w profilaktyce GBS
  3. Leczenie zakażeń GBS u noworodków i niemowląt
    1. Antybiotykoterapia empiryczna
    2. Leczenie potwierdzonego zakażenia GBS
    3. Specjalistyczna opieka nad noworodkiem z zakażeniem GBS
    4. Monitorowanie noworodka po leczeniu
  4. Nowe perspektywy w zapobieganiu i leczeniu GBS
    1. Szczepionka przeciwko GBS
    2. Immunoglobulina dożylna
    3. Podejścia alternatywne i wspomagające
  5. Podsumowanie zaleceń terapeutycznych
    1. Kluczowe zalecenia w leczeniu i profilaktyce GBS
    2. Kolejne rozdziały

Leczenie choroby paciorkowcowej grupy b

Choroba paciorkowcowa grupy B (GBS) wymaga odpowiedniego leczenia, które zależy od typu infekcji, wieku pacjenta oraz stanu klinicznego. Właściwe zastosowanie antybiotyków jest kluczowe zarówno w profilaktyce, jak i leczeniu zakażeń GBS12.

Antybiotykoterapia jako podstawa leczenia

Penicylina G pozostaje podstawowym antybiotykiem stosowanym w leczeniu zakażeń GBS, zarówno u dorosłych, jak i u noworodków. W przypadku alergii na penicylinę stosuje się alternatywne antybiotyki, takie jak klindamycyna, erytromycyna, fluorochinolony lub wankomycyna12. Czas trwania terapii zależy od obrazu klinicznego i lokalizacji zakażenia3.

W przypadku dorosłych z potwierdzoną infekcją GBS zwykle stosuje się następujące antybiotyki45:

  • Penicylina G – lek pierwszego wyboru w leczeniu inwazyjnych zakażeń GBS
  • Ampicylina – akceptowalna alternatywa dla penicyliny G
  • Wankomycyna – początkowe leczenie z wyboru u pacjentów z alergią na penicylinę (ze względu na możliwą oporność na klindamycynę)
  • Klindamycyna – przed zastosowaniem konieczne jest wykonanie badania wrażliwości ze względu na rosnącą oporność; doustna klindamycyna pozostaje doskonałym lekiem do kontynuacji terapii po zakończeniu leczenia parenteralnego w przypadku zakażeń kości, tkanek miękkich i płuc, jeśli izolat jest wrażliwy
  • Cefazolina lub ceftriakson – alternatywa dla penicyliny w leczeniu zakażeń GBS, nieskuteczne w zapaleniu opon mózgowo-rdzeniowych wywołanym przez GBS

Leczenie zakażeń GBS u noworodków

Leczenie zakażeń GBS u noworodków wymaga szybkiego wdrożenia antybiotykoterapii1. Początkowa terapia w przypadku podejrzenia posocznicy noworodkowej obejmuje ampicylinę i aminoglikozyd, najczęściej gentamycynę. Oba te antybiotyki wykazują aktywność przeciwko GBS, który jest najczęstszą przyczyną posocznicy noworodkowej. Dodatkowo, kombinacja ta ma efekt synergistyczny i jest bardziej skuteczna niż sama ampicylina lub penicylina G w eliminowaniu większości szczepów GBS in vitro i in vivo2.

Po potwierdzeniu GBS jako patogenu wywołującego zakażenie, udokumentowaniu jałowości krwioobiegu i płynu mózgowo-rdzeniowego (PMR) oraz zaobserwowaniu poprawy klinicznej, do ukończenia terapii należy stosować samą penicylinę G. Zalecenia dotyczące optymalnej dawki i czasu trwania leczenia powinny być dyktowane przez ognisko i ciężkość zakażenia3.

Zalecane dawkowanie penicyliny G dla niemowląt do 7 dnia życia wynosi 250 000 do 450 000 jednostek/kg/dobę, a dla niemowląt starszych niż 7 dni – 450 000 do 500 000 jednostek/kg/dobę1.

Czas trwania antybiotykoterapii w różnych zakażeniach GBS

Czas trwania leczenia antybiotykami zależy od rodzaju zakażenia12:

Postępowanie w przypadku zapalenia opon mózgowo-rdzeniowych wywołanego GBS

Niemowlęta z zapaleniem opon mózgowo-rdzeniowych wywołanym przez GBS powinny przejść ponowną punkcję lędźwiową 1-2 dni po rozpoczęciu terapii w celu udokumentowania jałowości PMR1. Jeśli posiew PMR jest ujemny, leczenie można ukończyć stosując samą penicylinę G przez co najmniej 14 dni. Jeśli jednak posiew PMR pozostaje dodatni, może być wymagany dłuższy kurs leczenia i diagnostyka2.

Badanie neuroobrazowe ze wzmocnieniem kontrastowym może pomóc w wykryciu przypadków nierozwiązanego zapalenia mózgu lub zapalenia komór, a także w identyfikacji rzadkich niemowląt z powikłaniami w postaci ropnia podtwardówkowego lub ropnia wewnątrzczaszkowego. Dodatkowo, obrazowanie może zidentyfikować powikłania naczyniowo-mózgowe, takie jak septyczne zapalenie zakrzepowe żył, które również może wpływać na rokowanie3.

Zaleca się rozważenie ponownej punkcji lędźwiowej po zakończeniu terapii w celu oceny liczby komórek i białka w PMR. Wyniki wskazujące na ponad 30% komórek wielojądrzastych lub stężenie białka powyżej 200 mg/dl są zgodne z zapaleniem mózgu lub zniszczeniem miąższu i mogą wymagać dłuższego czasu terapii. Wszystkie niemowlęta wracające do zdrowia po zapaleniu opon mózgowo-rdzeniowych wywołanym przez GBS powinny przejść diagnostyczny test słuchowych potencjałów wywołanych pnia mózgu (ABR)4.

Profilaktyka antybiotykowa śródporodowa

Profilaktyka antybiotykowa śródporodowa (intrapartum antibiotic prophylaxis, IAP) jest wskazana dla wszystkich matek z dodatnim wynikiem badania przesiewowego w kierunku GBS, rutynowo wykonywanego w 35-37 tygodniu ciąży1. Zmienione wytyczne z 2010 roku zalecają również IAP dla kobiet w ciąży, które miały bakteriurię GBS w dowolnym momencie obecnej ciąży lub mają w wywiadzie poprzednie dziecko z inwazyjną chorobą GBS2.

U kobiet w ciąży z nieznanym statusem GBS, IAP jest wskazana, jeśli występuje którykolwiek z następujących czynników ryzyka3:

  • Poród przedwczesny przed 37 tygodniem ciąży
  • Pęknięcie błon płodowych przez 18 godzin lub dłużej
  • Temperatura śródporodowa 100,4°F lub wyższa
  • Śródporodowy test amplifikacji kwasów nukleinowych (NAAT) jest dodatni

Profilaktyka antybiotykiem beta-laktamowym (najlepiej penicyliną) podawanym cztery lub więcej godzin przed porodem jest wysoce skuteczna w zapobieganiu wczesnej chorobie GBS4. Początkowa dawka penicyliny G wynosi 5 milionów jednostek, a następnie kolejne dawki 2,5-3,0 miliona jednostek co 4 godziny aż do porodu. Alternatywnie, pacjentki mogą zamiast tego otrzymać ampicylinę, początkowa dawka 2 g dożylnie, a następnie 1 g dożylnie co 4 godziny aż do porodu5.

Postępowanie w przypadku alergii na penicylinę

Definicja odpowiedniej IAP to podawanie penicyliny, ampicyliny lub cefazoliny co najmniej 4 godziny przed porodem1. Wszystkie inne leki, dawki lub czas trwania są uważane za niewystarczające do celów postępowania neonatologicznego.

Kobiety uczulone na penicylinę, które nie mają w wywiadzie anafilaksji, obrzęku naczynioruchowego, niewydolności oddechowej lub pokrzywki po podaniu penicyliny lub cefalosporyny, powinny otrzymać cefazolinę (początkowo 2 g, a następnie 1 g co 8 godzin aż do porodu)2.

W przypadku kobiet z ciężką alergią na penicylinę (anafilaksja, obrzęk naczynioruchowy, niewydolność oddechowa lub pokrzywka), należy przeprowadzić badanie wrażliwości, a na podstawie wzorców wrażliwości wyizolowanego organizmu GBS można podać klindamycynę (900 mg co 8 godzin aż do porodu) lub wankomycynę (1 g co 12 godzin aż do porodu)3. Należy jednak pamiętać, że ani IAP z klindamycyną, ani IAP z wankomycyną nie zostały ocenione pod kątem skuteczności w zapobieganiu wczesnej chorobie GBS u noworodków4.

Postępowanie w przypadku nawrotów zakażenia GBS

Wskaźnik nawrotów wczesnej choroby GBS wynosi około 1%1. Chociaż rzadko, nawrót może być spowodowany nieodpowiednią dawką lub czasem trwania terapii, ponownym zakażeniem drugim szczepem lub typem, ogniskami wspierającymi, zakażeniem HIV lub niedoborem odporności humoralnej2.

Niedobór odporności humoralnej może być zbyt wcześnie do definitywnego zdiagnozowania; jednak całkowite poziomy IgG są zwykle znacznie niższe niż oczekiwane dla wieku pacjenta. Ponadto należy przeanalizować badania wrażliwości z pierwszego zakażenia i nawrotu, aby zapewnić wrażliwość in vitro na penicylinę3.

Jeśli przyczyna nawrotu pozostaje nieznana, prawdopodobnym źródłem jest utrzymująca się kolonizacja błon śluzowych przez GBS. Antybiotyki beta-laktamowe, nawet podawane drogą parenteralną, nie eliminują skutecznie kolonizacji GBS. Niektóre badania wykazały korzyść ze stosowania ryfampicyny (20 mg/kg na dobę) w celu eliminacji kolonizacji śluzówki przez GBS, gdy podawana jest doustnie w ciągu ostatnich czterech dni terapii parenteralnej. Jednak nowsze badanie wykazało, że ryfampicyna nie eliminuje skutecznie kolonizacji GBS u niemowląt4.

Leczenie chirurgiczne w zakażeniach GBS

Chociaż terapia antybiotykowa powinna rozwiązać wiele zakażeń GBS, te obejmujące skórę, tkanki miękkie i kości mogą nie zostać wyleczone samymi antybiotykami i mogą wymagać interwencji chirurgicznej1. Konsultacja z chirurgiem i interwencja chirurgiczna są ważne1.

Pacjenci z zakażeniem tkanek miękkich, septycznym zapaleniem stawów, zapaleniem kości i szpiku, zapaleniem krążków międzykręgowych i ropniem nadtwardówkowym spowodowanym przez zakażenie GBS często wymagają operacji w połączeniu z parenteralną antybiotykoterapią w celu uzyskania pozytywnego rezultatu2.

Interwencje chirurgiczne mogą obejmować2:

  • Przypadki nagłe chirurgiczne: martwicze zapalenie powięzi, septyczne zapalenie stawów i ropień nadtwardówkowy
  • Drenaż ropniaka opłucnej w przypadkach zapalenia płuc
  • Wymiana zastawek serca u pacjentów z zapaleniem wsierdzia, bakteriemią lub posocznicą
  • Operacja plus antybiotyki parenteralne w przypadku zakażenia tkanek miękkich, septycznego zapalenia stawów, zapalenia kości i szpiku, zapalenia krążków międzykręgowych i ropnia nadtwardówkowego
  • Interwencja w celu złagodzenia niedrożności układu moczowo-płciowego u pacjentów z zakażeniami dróg moczowych
  • Drenaż ropni miednicy

Rola konsultacji specjalistycznych

W celu uzyskania optymalnych wyników u pacjentów z zakażeniem GBS mogą być wymagane różne konsultacje1. Specjalista chorób zakaźnych może być często pomocny w wyborze antybiotyku i czasu trwania terapii, szczególnie jeśli raport o wrażliwości wykazuje oporność na penicyliny, wankomycynę i cefalosporyny2.

Ogólna zasada wskazuje, że jeśli nie można zastosować ampicyliny, penicyliny, wankomycyny lub ceftriaksonu, zdecydowanie zaleca się konsultację ze specjalistą chorób zakaźnych3.

Leczenie GBS u kobiet w ciąży

Jeśli u kobiety w ciąży występują problemy medyczne z powodu GBS, prawdopodobnie otrzyma antybiotyki doustnie1. Najczęściej podaje się penicylinę, amoksycylinę (Amoxil, Larotid) lub cefaleksynę. Wszystkie są uważane za bezpieczne do stosowania w czasie ciąży2.

W przypadku wykrycia GBS w moczu, kobieta będzie potrzebowała antybiotyków natychmiast po zdiagnozowaniu w celu leczenia zakażenia układu moczowego; otrzyma również antybiotyki przez kroplówkę podczas porodu, aby zapobiec zakażeniu GBS u dziecka1.

Profilaktyka zakażeń GBS u noworodków

Zapobieganie zakażeniom GBS u noworodków opiera się na identyfikacji kobiet będących nosicielkami GBS i wdrożeniu odpowiedniej profilaktyki antybiotykowej podczas porodu1. Wczesne zakażenie GBS może być zapobiegane poprzez profilaktykę antybiotykową śródporodową (IAP). Jednak żadna skuteczna strategia nie została jeszcze zidentyfikowana odnośnie zapobiegania chorobie o późnym początku lub chorobie u dorosłych2.

Wskazania do profilaktyki antybiotykowej śródporodowej

Profilaktyka antybiotykowa śródporodowa jest wskazana w następujących sytuacjach12:

  • Wszystkie kobiety, których posiewy pochwowo-odbytnicze w 36 0/7-37 6/7 tygodniu ciąży są dodatnie w kierunku GBS, powinny otrzymać odpowiednią profilaktykę antybiotykową śródporodową, chyba że wykonywane jest cięcie cesarskie przed rozpoczęciem akcji porodowej w warunkach nienaruszonej błony płodowej
  • Kobiety z bakteriurią GBS w dowolnym momencie obecnej ciąży
  • Kobiety, które wcześniej urodziły dziecko z inwazyjną chorobą GBS
  • Kobiety z nieznanym wynikiem posiewu GBS podczas rozpoczęcia porodu, które mają czynniki ryzyka zakażenia GBS, takie jak:
    • Poród przedwczesny przed 37 tygodniem ciąży
    • Przedwczesne pęknięcie błon płodowych przez 18 godzin lub dłużej
    • Temperatura śródporodowa 38°C lub wyższa
    • Dodatni wynik testu amplifikacji kwasów nukleinowych (NAAT) podczas porodu

Antybiotyki stosowane w profilaktyce śródporodowej

Dożylna penicylina pozostaje lekiem z wyboru do profilaktyki śródporodowej, a dożylna ampicylina jest akceptowalną alternatywą1. Zalecane schematy dawkowania antybiotyków obejmują1:

  • Penicylina G: dawka początkowa 5 milionów jednostek dożylnie, a następnie 2,5-3 miliony jednostek dożylnie co 4 godziny aż do porodu
  • Ampicylina: dawka początkowa 2 g dożylnie, a następnie 1 g dożylnie co 4 godziny aż do porodu
  • Cefazolina (dla kobiet z alergią na penicylinę, które nie mają wysokiego ryzyka anafilaksji): dawka początkowa 2 g dożylnie, a następnie 1 g dożylnie co 8 godzin aż do porodu
  • Klindamycyna (dla kobiet z wysokim ryzykiem anafilaksji po ekspozycji na penicylinę, jeśli izolat GBS jest wrażliwy na klindamycynę): 900 mg dożylnie co 8 godzin aż do porodu
  • Wankomycyna (dla kobiet z wysokim ryzykiem anafilaksji po ekspozycji na penicylinę, jeśli izolat GBS nie jest wrażliwy na klindamycynę lub wrażliwość jest nieznana): 1 g dożylnie co 12 godzin aż do porodu

Moment rozpoczęcia profilaktyki antybiotykowej

Profilaktyka antybiotykowa nie jest zalecana przed rozpoczęciem porodu1. IAP powinna być rozpoczęta, gdy zidentyfikowana zostanie aktywna faza porodu2. Za odpowiednią profilaktykę uważa się podanie antybiotyków co najmniej cztery godziny przed porodem3.

Należy dążyć do pokrycia ≥4 godzin IAP przed porodem1. Nowe wytyczne definiują nieadekwatną profilaktykę antybiotykową śródporodową jako brak otrzymania co najmniej czterech godzin dożylnej penicyliny, ampicyliny lub cefazoliny przed porodem2.

Interwencje położnicze a profilaktyka antybiotykowa

Interwencje położnicze, gdy są konieczne, nie powinny być opóźniane wyłącznie w celu zapewnienia 4 godzin podawania antybiotyków przed porodem1. Jeśli planowane jest cięcie cesarskie, kobieta nie będzie potrzebowała dożylnych antybiotyków, ponieważ ryzyko przekazania GBS noworodkowi jest znacznie niższe niż w przypadku porodu pochwowego1.

Dodatni wynik badania na GBS nie wyklucza porodu w wannie lub basenie ani porodu przez wodę, o ile stosowana jest profilaktyka antybiotykowa1.

Postępowanie w przypadku przedwczesnego porodu

Jeśli kobieta wejdzie w przedwczesny poród przed wykonaniem badania przesiewowego w kierunku GBS, należy wykonać posiew lub test NAAT przy przyjęciu do szpitala1. Następnie kobieta będzie leczona antybiotykiem dożylnie do czasu urodzenia dziecka, zatrzymania porodu przez lekarza lub samoistnego zatrzymania porodu2.

Niemowlęta urodzone przed 35 tygodniem ciąży z powodu niewydolności szyjki macicy, przedwczesnego porodu, przedwczesnego pęknięcia błon płodowych, zakażenia wewnątrzmacicznego lub ostrego bądź niewyjaśnionego niepokojącego stanu płodu powinny otrzymać empiryczne antybiotyki ze względu na wysokie ryzyko choroby GBS1.

Szczególne sytuacje kliniczne w profilaktyce GBS

W niektórych sytuacjach klinicznych zalecane jest szczególne postępowanie w zakresie profilaktyki GBS1:

  • Zakażenie układu moczowego wywołane przez GBS w czasie ciąży: leczenie doustnymi antybiotykami w momencie rozpoznania oraz profilaktyka antybiotykowa śródporodowa
  • Wcześniejsze urodzenie dziecka z chorobą GBS: profilaktyka antybiotykowa śródporodowa
  • Gorączka podczas porodu: profilaktyka antybiotykowa śródporodowa
  • Pęknięcie błon płodowych trwające ponad 18 godzin: profilaktyka antybiotykowa śródporodowa
  • Poród przed 37 tygodniem ciąży bez przeprowadzonego badania w kierunku GBS: profilaktyka antybiotykowa śródporodowa

Leczenie zakażeń GBS u noworodków i niemowląt

Wczesne rozpoznanie i leczenie zakażeń GBS u noworodków jest kluczowe dla poprawy rokowania1. Jeśli noworodek rozwija objawy infekcji GBS lub podejrzewa się u niego infekcję, powinien być leczony antybiotykami jak najszybciej2.

Antybiotykoterapia empiryczna

Jeśli podejrzewa się wczesne zakażenie GBS, należy wykonać punkcję lędźwiową i analizę płynu mózgowo-rdzeniowego1. Dla niemowląt do siódmego dnia życia zalecana jest ampicylina z aminoglikozydem2.

Bez objawów zapalenia opon mózgowo-rdzeniowych lub ciężkiej choroby, dla niemowląt w wieku od 8 do 28 dni zalecana jest ampicylina i ceftazydym (Fortaz), a dla niemowląt w wieku od 29 do 90 dni zalecany jest ceftriakson (Rocephin)3.

Wankomycyna może być dodana do tych terapii, gdy istnieją dowody na zapalenie opon mózgowo-rdzeniowych lub w celu rozszerzenia spektrum działania u krytycznie chorych pacjentów4.

Leczenie potwierdzonego zakażenia GBS

Po potwierdzeniu zakażenia GBS zalecana jest monoterapia penicyliną G1. Czas trwania odpowiedniej terapii wynosi2:

  • 10 dni dla niepowikłanej bakteriemii
  • 14 dni dla niepowikłanego zapalenia opon mózgowo-rdzeniowych
  • Powikłane zakażenia mogą wymagać dłuższego czasu leczenia antybiotykami

W przypadku zapalenia opon mózgowo-rdzeniowych wywołanego przez GBS, początkowe leki mogą obejmować ampicylinę i gentamycynę. Po dodatkowej punkcji lędźwiowej wykazującej usunięcie GBS, lekarze mogą zmienić terapię na penicylinę G na kolejne 14 dni leczenia1.

Specjalistyczna opieka nad noworodkiem z zakażeniem GBS

Noworodki chore na GBS mogą wymagać opieki na oddziale intensywnej terapii noworodka (OITN)1. Oprócz antybiotyków dożylnych mogą być potrzebne inne zabiegi i specjalistyczna opieka, w zależności od ciężkości zakażenia i od tego, czy zakażenie powoduje poważne problemy, takie jak zapalenie opon mózgowo-rdzeniowych lub zapalenie płuc2.

W zależności od stanu dziecka, mogą być potrzebne płyny dożylne, tlen lub inne leki1. W bardzo ciężkich przypadkach może być stosowana terapia zwana pozaustrojowym natlenianiem błonowym (ECMO), która polega na używaniu pompy do cyrkulacji krwi przez sztuczne płuco z powrotem do krwiobiegu dziecka1.

Monitorowanie noworodka po leczeniu

Leczenie będzie kontynuowane, jeśli nie ma oznak zakażenia po co najmniej 36 godzinach i wszystkie testy są negatywne1. Niektóre badania pokazują korzyść ze stosowania ryfampicyny (20 mg/kg na dobę) w celu eliminacji kolonizacji śluzówki przez GBS, gdy podawana jest doustnie w ciągu ostatnich czterech dni terapii parenteralnej1.

Nowe perspektywy w zapobieganiu i leczeniu GBS

Pomimo skutecznej profilaktyki antybiotykowej śródporodowej, zakażenia GBS nadal stanowią istotny problem zdrowotny, szczególnie zakażenia o późnym początku. Prowadzone są badania nad nowymi metodami zapobiegania tym zakażeniom1.

Szczepionka przeciwko GBS

Chociaż nie jest jeszcze dostępna, naukowcy pracują nad szczepionką przeciwko GBS1. Skuteczna szczepionka przeciwko GBS przeznaczona dla kobiet w ciąży oferuje potencjał ochrony niemowląt zarówno przed wczesną, jak i późną chorobą GBS poprzez przezszczepowe przeniesienie przeciwciał matczynych, a także zmniejszenie obciążenia chorobą na całym świecie1.

Rozwój szczepionek przeciwko paciorkowcom grupy B (GBS) do immunizacji matczynej został zidentyfikowany przez Komitet Doradczy ds. Rozwoju Produktów dla Szczepionek (PDVAC) jako priorytet, ze względu na duże obciążenie zdrowia publicznego spowodowane przez GBS w krajach o niskich i średnich dochodach2.

Strategicznym celem dla szczepionek GBS jest opracowanie i licencjonowanie bezpiecznych, skutecznych i przystępnych cenowo szczepionek GBS do immunizacji matczynej podczas ciąży w celu zapobiegania martwym urodzeniom związanym z GBS i inwazyjnej chorobie GBS u noworodków i małych niemowląt, odpowiednich do stosowania w krajach o wysokich, średnich i niskich dochodach1.

Badania skuteczności szczepionek GBS będą wymagać dużej liczby uczestników, dlatego należy rozważyć początkowe licencjonowanie szczepionki w oparciu o immunologiczne korelaty ochrony (CoP), a następnie badania po uzyskaniu licencji w celu oceny skuteczności i oceny zmniejszenia obciążenia chorobą2.

Immunoglobulina dożylna

Immunoglobulina dożylna (IVIG) jest alternatywną strategią leczenia, która została zaproponowana dla zakażenia GBS w pediatrii1. Wykazano, że IVIG jest skuteczna w zmniejszaniu ryzyka zakażenia GBS u noworodków i poprawie wyników u niemowląt z zakażeniem GBS2.

Jednak IVIG jest droga i nie jest powszechnie dostępna, a dane dotyczące jej długoterminowego bezpieczeństwa są ograniczone3.

Podejścia alternatywne i wspomagające

Probiotyki, w tym wyspecjalizowane szczepy Bifidobacterium i Lactobacillus, mogą pomóc przywrócić równowagę bakterii jelitowych i mogą pozwolić lekarzowi na zmniejszenie wymaganej dawki antybiotyków1.

Związki wyizolowane z surowego czosnku mogą mieć właściwości przeciwdrobnoustrojowe przeciwko GBS (jednak nie należy samodzielnie podawać surowego czosnku ani innych form czosnku jako leczenia, ponieważ potrzebne są dalsze badania w celu określenia najbardziej odpowiedniej metody podawania w celu skutecznego zapobiegania przenoszeniu GBS na noworodka)2.

Istotne jest podkreślenie, że domowe środki zaradcze same w sobie są niewystarczające, aby poradzić sobie ze złożonością i ciężkością tego schorzenia1. Jeśli kobieta podejrzewa, że ma zakażenie GBS, lekarz naturopata będzie stosował antybiotyki i kombinację zintegrowanych terapii, w zależności od sytuacji2.

Opieka wspomagająca jest ważna dla stabilizacji stanu niemowlęcia i zarządzania wszelkimi powikłaniami, które mogą się pojawić1.

Podsumowanie zaleceń terapeutycznych

W leczeniu i profilaktyce zakażeń GBS kluczowe znaczenie ma właściwy dobór antybiotyków oraz ich odpowiednie dawkowanie12.

Sytuacja kliniczna Zalecane leczenie Dawkowanie Czas trwania terapii
Profilaktyka śródporodowa u kobiet z dodatnim wynikiem badania GBS Penicylina G (lek z wyboru)
Ampicylina (alternatywnie)		 Penicylina G: 5 mln j. początkowa dawka, następnie 2,5-3 mln j. co 4h
Ampicylina: 2 g początkowa dawka, następnie 1 g co 4h		 Od rozpoczęcia porodu do porodu
Profilaktyka śródporodowa u kobiet z alergią na penicylinę (niskie ryzyko anafilaksji) Cefazolina 2 g początkowa dawka, następnie 1 g co 8h Od rozpoczęcia porodu do porodu
Profilaktyka śródporodowa u kobiet z alergią na penicylinę (wysokie ryzyko anafilaksji) Klindamycyna (jeśli GBS wrażliwy)
Wankomycyna (jeśli GBS oporny na klindamycynę)		 Klindamycyna: 900 mg co 8h
Wankomycyna: 1 g co 12h		 Od rozpoczęcia porodu do porodu
Zakażenie GBS u noworodków (leczenie empiryczne) Ampicylina + aminoglikozyd (najczęściej gentamycyna) Zależy od wieku i masy ciała Do potwierdzenia/wykluczenia zakażenia
Potwierdzone zakażenie GBS u noworodków bez zapalenia opon mózgowo-rdzeniowych Penicylina G 250 000-450 000 j./kg/dobę (niemowlęta do 7 dni)
450 000-500 000 j./kg/dobę (niemowlęta powyżej 7 dni)		 10 dni
Zapalenie opon mózgowo-rdzeniowych wywołane przez GBS Penicylina G Jak wyżej Minimum 14 dni
Zakażenie stawów/zapalenie kości i szpiku Penicylina G Jak wyżej 3-4 tygodnie
Zapalenie wsierdzia/zapalenie komór mózgu Penicylina G Jak wyżej Minimum 4 tygodnie
Bakteriemia GBS u dorosłych Penicylina G
Ampicylina		 Zależy od ciężkości zakażenia 10 dni

Kluczowe zalecenia w leczeniu i profilaktyce GBS

Podsumowując, najważniejsze zalecenia dotyczące leczenia i profilaktyki zakażeń GBS obejmują123:

  • Penicylina G pozostaje lekiem z wyboru w leczeniu zakażeń GBS zarówno u dorosłych, jak i u niemowląt
  • Profilaktyka antybiotykowa śródporodowa znacząco zmniejsza ryzyko wczesnego zakażenia GBS u noworodków
  • Optymalny czas podania antybiotyków to co najmniej 4 godziny przed porodem
  • W przypadku alergii na penicylinę należy dostosować wybór antybiotyku na podstawie ciężkości reakcji alergicznej i wyników badania wrażliwości
  • Zakażenia tkanek miękkich i kości mogą wymagać interwencji chirurgicznej oprócz antybiotykoterapii
  • Czas trwania leczenia antybiotykami zależy od lokalizacji i ciężkości zakażenia
  • Badania przesiewowe kobiet w ciąży w kierunku GBS w 35-37 tygodniu ciąży są kluczowe dla identyfikacji nosicielek wymagających profilaktyki
  • Trwają prace nad szczepionką przeciwko GBS, która może w przyszłości zapobiegać zakażeniom wczesnym i późnym

Skuteczne leczenie i profilaktyka zakażeń GBS wymagają ścisłej współpracy między położnikami, neonatologami i specjalistami chorób zakaźnych, a także przestrzegania aktualnych wytycznych klinicznych12.

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Group B strep infection | March of Dimes
    https://www.marchofdimes.org/find-support/topics/planning-baby/group-b-strep-infection
    Screening after 35 weeks of pregnancy helps to identify the presence of Group B Strep […] The good news is that your provider can give you treatment during labor and childbirth that protects your baby from Group B strep. […] If you have GBS and you’re given antibiotics during labor and birth, your treatment helps protect your baby from the infection. […] If your GBS test at 36 weeks shows you have a GBS present in your results, your provider gives you medicine called an antibiotic during labor and birth through an IV (through a needle into a vein). […] Treatment with antibiotics helps prevent your baby from getting the infection. […] Penicillin is the best antibiotic for most people. […] If you’re allergic to penicillin, or if you’re not sure if you are, talk to your provider to discuss the best option for you.
  • #1 Group B Streptococcus (Streptococcus agalactiae)
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6432937/
    Penicillin G remains the mainstay of therapy, although reduced penicillin susceptibility has been observed in select isolates. […] In patients who demonstrate an anaphylactic or severe allergy to beta-lactam antimicrobials, alternative therapies include clindamycin, erythromycin, fluoroquinolones, and vancomycin. […] Penicillin G is the first-line treatment for invasive GBS disease in adults. […] The duration of therapy depends on the clinical presentation. […] Ten days of therapy is generally acceptable for bacteremia, pneumonia, pyelonephritis, and skin/soft tissue infections. […] Longer durations of treatment are recommended for meningitis (minimum 14 days) and for osteomyelitis, endocarditis, and ventriculitis (minimum 4 weeks). […] In neonates with presumptive EOD, empiric therapy with ampicillin combined with an aminoglycoside is the standard of care.
  • #1 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    The initial therapy for suspected neonatal sepsis is ampicillin and an aminoglycoside, typically gentamicin. Both ampicillin and gentamicin have activity against GBS, which is the most common cause of neonatal sepsis. Additionally, this combination has a synergistic effect and is more effective than either ampicillin or penicillin G alone in killing most GBS strains in vitro and in vivo. Following confirmation of GBS as the causative pathogen, sterility of the bloodstream and cerebrospinal fluid (CSF) are documented, and clinical improvement is observed; penicillin G alone should be used to complete therapy. Recommendations concerning the optimal dose and duration of treatment should be dictated by the focus and severity of the infection.[14] […] Infants with GBS meningitis should undergo a second lumbar puncture 1 to 2 days into therapy to document CSF sterility. If CSF culture is negative, treatment therapy can be completed using penicillin G alone for a minimum of 14 days. If CSF culture remains positive, however, a longer treatment course and diagnostic evaluation may be warranted. A contrast-enhanced neuroimaging study can help reveal unresolved cerebritis cases or ventriculitis and can identify the rare infant with complications of subdural empyema or intracranial abscess. Additionally, imaging may identify cerebrovascular complications such as septic thrombophlebitis that can also affect the prognosis. A repeat lumbar puncture should be considered at the completion of therapy to evaluate CSF cell count and protein. Findings of polymorphonuclear cells greater than 30% or protein higher than 200 mg/dL are consistent with cerebritis or parenchymal destruction and may warrant a longer therapy duration. All infants recovering from GBS meningitis should undergo a diagnostic auditory brainstem response (ABR) test.
  • #1 Group B Streptococcus (Streptococcus agalactiae)
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6432937/
    Once GBS is isolated, penicillin G monotherapy is recommended for treatment of invasive GBS infection in infants. […] Recommended dosing of penicillin G for infants up to 7 days of age is 250,000 to 450,000 units/kg/day and 450,000 to 500,000 units/kg/day for infants older than 7 days. […] Ten days of appropriate therapy is recommended for uncomplicated bacteremia and 14 days for uncomplicated meningitis, while complicated infections may require a longer duration of antimicrobial therapy. […] Septic arthritis or osteomyelitis is treated for 3 to 4 weeks, and at least 4 weeks of therapy is recommended for endocarditis or ventriculitis.
  • #1 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    Intrapartum antibiotic prophylaxis (IAP) is indicated for all mothers with a positive GBS screening culture routinely obtained at 35 to 37 weeks gestation. Revised guidelines from 2010 also recommend IAP for pregnant women who have a history of GBS bacteriuria at any point during the current pregnancy or have a history of a previous infant with invasive GBS disease. In pregnant women with unknown GBS status, IAP is indicated if any of the following risk factors are present: (1) preterm delivery less than 37 weeks gestation, (2) membrane rupture for 18 hours or greater, (3) an intrapartum temperature of 100.4 F or higher, or (4) intrapartum nucleic acid amplification test (NAAT) is positive. […] Prophylaxis with a beta-lactam antibiotic (preferably penicillin) given four or more hours before delivery is highly effective for early-onset disease prevention. The initial dose of penicillin G is 5 million units, followed by subsequent doses of 2.5 to 3.0 million units every 4 hours until delivery. Alternatively, patients may instead receive ampicillin, 2 g IV initial dose, then 1 g IV every 4 hours until delivery.
  • #1 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    The definition of adequate IAP is administering penicillin, ampicillin, or cefazolin at least 4 hours before delivery.[16] All other medications, doses, or durations are considered inadequate for purposes of neonatal management. Women allergic to penicillin who do not have a history of anaphylaxis, angioedema, respiratory distress, or urticaria after administering penicillin or a cephalosporin should receive cefazolin (2 g initially and 1 g every 8 hours until delivery). For women with severe penicillin allergy (anaphylaxis, angioedema, respiratory distress, or urticaria), susceptibility testing should be performed, and clindamycin (900 mg every 8 hours until delivery) or vancomycin (1 g every 12 hours until delivery) can be given to based on susceptibility patterns of the isolated GBS organism. Furthermore, neither clindamycin IAP nor vancomycin IAP has been evaluated for efficacy in preventing early-onset GBS neonatal disease.
  • #1 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    Infants with bacteremia without focus should receive a total of a 10-day course of IV antibiotics. Relapses, although rare, have been documented if utilizing shorter courses. Oral therapy is not sufficient and has no place in the management of invasive GBS disease. The treatment duration for patients with septic arthritis, osteomyelitis, or endocarditis appears in the table. […] The recurrence rate for early-onset GBS disease is approximately 1%. Although rare, recurrence can be due to inadequate dose or duration of therapy, reinfection with a second strain or type, supportive foci, HIV infection, or a humoral immune deficiency. Humoral immune deficiency may be too early to diagnose definitively; however, total IgG levels are usually significantly lower than expected for the patients age. Furthermore, susceptibility testing from the first infection and the recurrent episode should be analyzed to ensure in vitro susceptibility to penicillin. If the reason for the recurrence remains unknown, persistent mucous membrane colonization with GBS is the likely source. Beta-lactam antibiotics, even when administered by the parenteral route, do not eradicate GBS colonization reliably. Some studies have shown the benefit of rifampin (20 mg/kg per day) to eradicate mucosal GBS colonization when given orally during the last four days of parenteral therapy. However, a more recent study showed a failure of rifampin to eradicate GBS colonization in infants reliably.[15]
  • #1 Group B Streptococcus (GBS) Infections: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/229091-overview
    Although medical therapy should resolve many GBS infections, those involving skin, soft tissue, and bone may not be resolved with antibiotics alone and may require surgical intervention, including the following infections: […] Surgical emergencies: Necrotizing fasciitis, septic arthritis, and epidural abscess […] Empyema drainage in cases of pneumonia […] Heart valve replacement in patients with endocarditis, bacteremia, or sepsis […] Surgery plus parenteral antibiotics for soft-tissue infection, septic arthritis, osteomyelitis, diskitis, and epidural abscess […] Intervention for relief of genitourinary obstruction in patients with urinary tract infections […] Drainage for pelvic abscesses.
  • #1 Group B Streptococcus (GBS) Infections Treatment & Management: Medical Care, Surgical Care, Consultations
    https://emedicine.medscape.com/article/229091-treatment
    Therefore, sensitivity testing should be done before these agents are used. Oral clindamycin remains an excellent agent for use after a course of parenteral therapy for bone, soft-tissue, and lung infections, if the isolate is susceptible. […] Because of possible resistance to clindamycin, vancomycin remains the initial treatment of choice for GBS infection in patients who are allergic to penicillin. Penicillin, ampicillin, and vancomycin remain the treatments of choice for endocarditis. […] In general, if ampicillin, penicillin, vancomycin, or ceftriaxone cannot be used, consultation with an infectious diseases specialist is strongly recommended. […] Consultation with a surgeon and surgical intervention are important. […] Patients with soft-tissue infection, septic arthritis, osteomyelitis, diskitis, and epidural abscess caused by GBS infection often require surgery combined with parenteral antibiotic therapy for resolution.
  • #1 Group B Streptococcus (GBS) Infections Treatment & Management: Medical Care, Surgical Care, Consultations
    https://emedicine.medscape.com/article/229091-treatment
    Various consultations may be required for optimal outcomes in patients with GBS infection. An infectious diseases specialist can often be helpful in choosing the antibiotic and duration of therapy, especially if the susceptibility report shows resistance to penicillins, vancomycin, and cephalosporins.
  • #1 Group B strep disease – Diagnosis & treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/group-b-strep/diagnosis-treatment/drc-20351735
    If your baby tests positive for group B strep, the baby receives IV antibiotics through a vein. Depending on your baby’s condition, the baby might need IV fluids, oxygen or other medicines. […] Antibiotics can treat group B strep infection in adults. The choice of antibiotic depends on the location and extent of the infection. It also depends on your specific circumstances. […] If you’re pregnant and you have medical problems because of group B strep, you’ll likely receive antibiotics by mouth. Most often, you’ll be given penicillin, amoxicillin (Amoxil, Larotid) or cephalexin. All are considered safe to take during pregnancy.
  • #1 Group B Streptococcus (GBS) in pregnancy and newborn babies | RCOG
    https://www.rcog.org.uk/for-the-public/browse-our-patient-information/group-b-streptococcus-gbs-in-pregnancy-and-newborn-babies/
    If GBS is found in your urine then you will need antibiotics as soon as it is diagnosed to treat your urinary tract infection; you will also be offered antibiotics through a drip during labour to prevent GBS infection in your baby. […] Babies with signs of GBS infection or babies who are suspected to have the infection should be treated with antibiotics as soon as possible. Antibiotics can be life-saving when given to babies with suspected infection. Treatment will be stopped if there is no sign of infection after at least 36 hours, and all the tests are negative.
  • #1 Clinical Overview of Group B Strep Disease | Group B Strep | CDC
    https://www.cdc.gov/group-b-strep/hcp/clinical-overview/index.html
    Help prevent early-onset GBS disease through intrapartum antibiotic prophylaxis. […] Early-onset GBS disease can be prevented through intrapartum antibiotic prophylaxis. However, no effective strategy has yet been identified for how to prevent late-onset disease or adult disease. […] There has been widespread use of intrapartum antibiotic prophylaxis to prevent early-onset GBS disease.
  • #1 Prevention of Group B Streptococcal Early-Onset Disease in Newborns | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns
    Targeted intravenous intrapartum antibiotic prophylaxis has demonstrated efficacy for prevention of GBS early-onset disease (EOD) in neonates born to women with positive antepartum GBS cultures and women who have other risk factors for intrapartum GBS colonization. Neither antepartum nor intrapartum oral or intramuscular regimens have been shown to be comparably effective in reducing GBS EOD. […] All women whose vaginalrectal cultures at 36 0/737 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes. […] If the prenatal GBS culture result is unknown when labor starts, intrapartum antibiotic prophylaxis is indicated for women who have risk factors for GBS EOD.
  • #1 Prevention of Group B Streptococcal Early-Onset Disease in Newborns | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns
    Intravenous penicillin remains the agent of choice for intrapartum prophylaxis, with intravenous ampicillin as an acceptable alternative. […] For women with a high risk of anaphylaxis after exposure to penicillin, the laboratory requisitions for ordering antepartum GBS screening cultures should indicate clearly the presence of penicillin allergy. […] Intravenous vancomycin remains the only pharmacokinetically and microbiologically validated option for intrapartum antibiotic prophylaxis in women who report a high-risk penicillin allergy and whose GBS isolate is not susceptible to clindamycin. […] Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth.
  • #1 Prevention of Perinatal Group B Streptococcal Disease: Updated CDC Guideline | AAFP
    https://www.aafp.org/pubs/afp/issues/2012/0701/p59.html
    Penicillin or ampicillin should be administered intravenously for intrapartum chemoprophylaxis against neonatal group B streptococcal infection. Cefazolin is an alternative in women with penicillin allergy who do not have a high risk of anaphylaxis. […] The recommended approach for antibiotic dosing is shown in […] Penicillin is the recommended antibiotic for intrapartum chemoprophylaxis of group B streptococcal disease; ampicillin is an acceptable alternative. […] The new guideline clarifies that women who are allergic to penicillin are at risk of anaphylaxis if they have a history of anaphylaxis, angioedema, respiratory distress, or urticaria after administration of penicillin or a cephalosporin. […] Clindamycin (900 mg intravenously every eight hours until delivery) is the drug of choice if the GBS isolate is susceptible to clindamycin and erythromycin, and if there is no inducible clindamycin resistance. Vancomycin (1 g intravenously every 12 hours until delivery) is recommended if testing shows resistance or inducible resistance to clindamycin. […] The new guideline defines inadequate intrapartum chemoprophylaxis as failure to receive at least four hours of intravenous penicillin, ampicillin, or cefazolin before delivery.
  • #1 Group B streptococcus (GBS) – screening and management | Safer Care Victoria
    https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/maternity/group-b-streptococcus-gbs-screening-and-management
    Antibiotic prophylaxis is not recommended prior to the onset of labour. […] Recommend IAP to women with identified risk factors when active labour is identified: Intrapartum antibiotic prophylaxis flowchart. […] Adequate prophylaxis is considered to be commenced at least four hours prior to birth. […] Benzylpenicillin is the antibiotic of choice – IV penicillin and ampicillin are equally effective against GBS, but penicillin is preferable due to its narrower spectrum of activity. […] A GBS positive screening result is not a preclusion to labour in the bath or pool, or birth through water, as long as antibiotic prophylaxis occurs. […] Treat all unwell babies for suspected sepsis, irrespective of maternal GBS status or adequate IAP.
  • #1 Group B streptococcus (GBS) – screening and management | Safer Care Victoria
    https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/maternity/group-b-streptococcus-gbs-screening-and-management
    Maternal streptococcus agalactiae, or Group B streptococcus (GBS) colonisation, can lead to early onset sepsis (EOS) infection in the baby and associated morbidity. […] Identifying women who are at risk of having a baby with GBS enables treatment to be given during labour to reduce the risk of transmission of infection to the baby. […] Intrapartum antibiotic prophylaxis (IAP) to women at risk of transmitting GBS to their baby, is associated with a reduction in (but does not eliminate) EOS. However it does not prevent late onset sepsis (LOS). […] Treat all unwell babies for suspected sepsis, irrespective of maternal GBS status or adequate IAP. […] If any of the above risk factors are identified, IAP is recommended once active labour is identified. […] Aim for ≥4 hours of IAP coverage prior to birth.
  • #1 Patient education: Group B streptococcus and pregnancy (Beyond the Basics) – UpToDate
    https://www.uptodate.com/contents/group-b-streptococcus-and-pregnancy-beyond-the-basics/print
    If you have a planned cesarean birth („C-section”), you will not need IV antibiotics because the risk of passing GBS on to the newborn is much lower than with a vaginal birth. However, even if you plan ahead to have a C-section, you should still be tested for GBS during pregnancy. […] If you have an allergy to penicillin, be sure your health care providers are aware of this allergy early in your pregnancy. […] If you have a serious allergy and you carry GBS, your GBS should be tested in the laboratory to determine which antibiotic should be used during labor. […] Late-onset GBS — It is important to note that young infants up to age three months can also develop sepsis, meningitis, and other serious GBS infections. Being treated with an antibiotic during labor does not reduce the chance that your baby will develop this later type of infection that can happen from approximately 8 to 90 days after birth. There is currently no way to prevent late-onset GBS disease.
  • #1 Patient education: Group B streptococcus and pregnancy (Beyond the Basics) – UpToDate
    https://www.uptodate.com/contents/group-b-streptococcus-and-pregnancy-beyond-the-basics/print
    Newborn GBS infection and infection of the uterus after delivery can usually be prevented by giving an intravenous (IV) antibiotic during labor to anyone who is a GBS carrier when giving birth. […] If you are found to have GBS during pregnancy, even if you have no symptoms of infection, you will receive intravenous (IV) antibiotics during labor to significantly lower the risk of passing the bacteria on to your newborn. […] Being treated with an antibiotic during labor greatly reduces the chance that you or your newborn will develop a serious infection related to GBS in the first week after birth. […] Penicillin is the antibiotic typically used in this situation, although another antibiotic may be used if you have a penicillin allergy. […] If you go into preterm labor — If you go into preterm (premature) labor before you’ve been tested to find out if you carry GBS, a swab culture or NAAT will be done when you are admitted to the hospital. Then you will be treated with an IV antibiotic until your baby is born or the labor is stopped by your health care provider or labor stops on its own.
  • #1 Group B Streptococcus Disease: AAP Updates Guidelines for the Management of At-Risk Infants | AAFP
    https://www.aafp.org/pubs/afp/issues/2020/0315/p378.html
    Maternal screening for GBS and intrapartum antibiotics for positive screening are important for reducing early-onset GBS disease risk. […] For well-appearing infants born at 35 weeks’ gestation or later, determining treatment with a risk calculator and clinical monitoring for 36 to 48 hours are alternatives to empiric antibiotics, even with maternal intrapartum fever. […] Infants born before 35 weeks’ gestation because of cervical insufficiency, preterm labor, premature rupture of membranes, intra-amniotic infection, or acute or unexplained nonreassuring fetal status should receive empiric antibiotics because of the high risk of GBS disease. […] Infants born before 35 weeks’ gestation because of other causes should receive empiric antibiotics for insufficient intrapartum antibiotics, maternal intrapartum fever, or newborn signs of illness.
  • #1 Group B strep disease – Symptoms & causes – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/group-b-strep/symptoms-causes/syc-20351729
    If you’re pregnant, get a group B strep screening test during your third trimester. If you have this type of bacteria in your body, medicines called antibiotics given to you during labor can protect your baby. […] Medicine can prevent group B bacteria from spreading to your baby during labor or delivery. An antibiotic through a needle in a vein, also called an IV, is given to you when labor begins. The antibiotic is usually penicillin or a related medicine. […] If you’re allergic to penicillin or related medicines, you might receive another antibiotic such as clindamycin or vancomycin instead. But it’s not clear how well these other antibiotics work. […] Antibiotic treatment during labor also is recommended if you: Have a urinary tract infection. Delivered a previous baby with group B strep disease. Get a fever during labor. Haven’t delivered your baby within 18 hours of your water breaking. Go into labor before 37 weeks and haven’t been tested for group B strep. […] Although it’s not available yet, researchers are working on a group B strep vaccine. It could help prevent group B strep infections in the future.
  • #1 Group B Strep in Pregnancy
    https://patient.info/pregnancy/strep-b-in-pregnancy
    If your baby has GBS infection, early diagnosis and treatment are essential as any delay can be very serious or even fatal. If your baby becomes very unwell or develops any signs that suggest possible GBS infection, they should be treated with antibiotics straightaway. […] Most early-onset GBS infections (in babies aged 0-6 days) can be prevented by giving intravenous antibiotics during labour to women whose babies are at particular risk of GBS infection: […] If GBS is found in your urine then you will need antibiotics, as soon as it is diagnosed, to treat your urinary tract infection. You will also be offered antibiotics through a drip during labour to prevent GBS infection in your baby. […] Babies with signs of GBS infection or babies who are suspected to have the infection should be treated with antibiotics as soon as possible. Treatment will be stopped if there is no sign of infection after at least 36 hours, and all the tests are negative.
  • #1 Group B Streptococcus Disease: AAP Updates Guidelines for the Management of At-Risk Infants | AAFP
    https://www.aafp.org/pubs/afp/issues/2020/0315/p378.html
    If early-onset GBS disease is highly suspected, a lumbar puncture and analysis of cerebrospinal fluid should be performed. […] Ampicillin with an aminoglycoside is recommended for infants up to seven days of age. […] Without signs of meningitis or severe illness, ampicillin and ceftazidime (Fortaz) are recommended for infants eight to 28 days of age and ceftriaxone (Rocephin) is recommended for infants 29 to 90 days of age. […] Vancomycin may be added to these treatments when there is evidence of meningitis or to expand the coverage in critically ill patients.
  • #1 Group B Streptococcal (GBS) Meningitis: Everything to Know
    https://www.healthline.com/health/meningitis/gbs-meningitis
    What is the treatment for GBS meningitis? Treatment for meningitis involves taking various antibiotics. The Centers for Disease Control and Prevention (CDC) notes that its important to start antibiotic treatment as soon as possible. […] Initial drugs may include ampicillin and gentamicin. Once an additional spinal tap shows the GBS has cleared, doctors may switch you or your child to penicillin G for another 14 days of treatment. […] Your doctor will adjust treatment as needed, depending on how your case or your child’s case is progressing or resolving.
  • #1 Group B Streptococcus | Children’s Hospital of Philadelphia
    https://www.chop.edu/conditions-diseases/group-b-streptococcus
    Treatment of GBS depends on when GBS infection is diagnosed — during pregnancy or after delivery. Specific treatment for GBS will be determined by your physician based on: […] If the mother has a positive GBS culture during pregnancy, the CDC and the American College of Obstetricians and Gynecologists recommend treatment with intravenous (IV) antibiotics during labor to reduce the risk of transmission of the infection to the baby. Penicillin is the most common antibiotic that is given. […] Newborns who become ill with GBS infection may require care in the newborn intensive care unit (NICU). They are usually treated with IV antibiotics. Other treatments and specialized care may be needed depending on the severity of the infection and whether the infection causes serious problems such as meningitis or pneumonia.
  • #1 Group B streptococcal septicemia of the newborn: MedlinePlus Medical EncyclopediaLock
    https://medlineplus.gov/ency/article/001366.htm
    The baby is given antibiotics through a vein (IV). […] Other treatment measures may involve: […] A therapy called extracorporeal membrane oxygenation (ECMO) may be used in very severe cases. ECMO involves using a pump to circulate blood through an artificial lung back into the bloodstream of the baby.
  • #1
    https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/group-b-streptococcus-(gbs)
    Streptococcus agalactiae (Group B streptococcus or GBS) is a leading cause of neonatal and infant sepsis and meningitis globally. […] Administration of intrapartum antibiotic prophylaxis (IAP) to pregnant women with GBS colonization can substantially reduce the incidence of early-onset GBS disease, but IAP does not prevent late-onset GBS disease, which in most cases are transmitted postnatally. […] An effective maternal GBS vaccine targeting pregnant women offers the potential to protect infants against both early- and late-onset GBS disease through transplacental transfer of maternal antibodies, and reduce disease burden worldwide. […] The development of Group B Streptococcus (GBS) vaccines for maternal immunization has been identified by the Product Development for Vaccines Advisory Committee (PDVAC) as a priority, because of the major public health burden posed by GBS in LMIC.
  • #1
    https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/group-b-streptococcus-(gbs)
    The strategic goal for GBS vaccines is to develop and license safe, effective and affordable GBS vaccines for maternal immunization during pregnancy to prevent GBS-related stillbirth and invasive GBS disease in neonates and young infants, appropriate for use in high-, middle- and low-income countries. […] Efficacy studies for GBS vaccine will require a large number of participants, therefore initial vaccine licensure based on immunological correlates of protection (CoP) should be explored, followed by post licensure studies to assess effectiveness and to evaluate the reduction in disease burden.
  • #1 Clinical Characteristics and Treatment Strategies for Group B Streptococcus (GBS) Infection in Pediatrics: A Systematic Review
    https://www.mdpi.com/1648-9144/59/7/1279
    However, concerns have been raised regarding the overuse of antibiotics, which can lead to the development of antibiotic-resistant strains of bacteria. […] Intravenous immunoglobulin (IVIG) is an alternative treatment strategy that has been proposed for GBS infection in pediatrics. […] IVIG has been shown to be effective in reducing the risk of GBS infection in neonates and improving outcomes in infants with GBS infection. […] However, IVIG is expensive and not widely available, and there are limited data on its long-term safety. […] Supportive care is important to stabilize the infant’s condition and manage any complications that may arise. […] The review will consider studies that evaluate the efficacy and safety of prophylactic antibiotics, IVIG, and supportive care in the treatment of GBS infection in pediatrics. […] This review will also assess the impact of these treatments on long-term outcomes, such as neurodevelopmental outcomes and the development of antibiotic resistance.
  • #1 Natural and Integrative Treatments for Group B Strep in Women
    https://naturemed.org/natural-and-integrative-treatments-for-group-b-strep-in-women/
    Compounds isolated from raw garlic may have antimicrobial properties for GBS (however, do not self-administer raw garlic or other forms of garlic as a treatment as further research needs to be done to determine the most appropriate method of administration to effectively prevent the transmission of GBS to a newborn). […] Probiotics, including specialized Bifidobacterium and Lactobacillus strains, can help restore the balance of gut bacteria and may allow the doctor to reduce the required dosage of antibiotics.
  • #1 Natural and Integrative Treatments for Group B Strep in Women
    https://naturemed.org/natural-and-integrative-treatments-for-group-b-strep-in-women/
    If you are testing positive for GBS, ask your physician to do susceptibility and allergy testing for specific oral antibiotics first, like penicillin, as IV antibiotics will likely be administered during labor to reduce the risk of transmission to the baby. […] Timely administration of IV antibiotics by an attending physician or healthcare provider can significantly reduce the risk of transmission of bacterial infection to the baby and prevent serious infections. […] Intravenous antibiotics are the first course of antibiotic treatment, though naturopathic doctors may offer other therapies to support the body. These natural remedies include probiotics, herbs and supplements, and dietary modifications. […] If a woman suspects they have a GBS infection, a naturopathic physician (ND) will use antibiotics and a combination of integrative treatments, depending on the situation. It is imperative to protect the health of the woman and fetus; therefore, home remedies alone are insufficient to address this conditions complexity and severity.
  • #1
    https://www.healthychildren.org/English/news/Pages/AAP-Updates-Guidance-on-Infants-With-Group-B-Strep-Disease.aspx
    Pediatricians update neonatal recommendations that, together with revised maternal guidelines by the American College of Obstetricians and Gynecologists, replace the CDC 2010 Perinatal GBS Prevention guidelines. […] The American Academy of Pediatrics, issuing a clinical report on managing infants at risk for Group B Streptococcal Disease, affirms its support for universal testing of pregnant women so that antibiotic treatment may be provided during delivery to protect the newborn. […] AAP is pleased to support maternal policies and procedures that help safeguard infants from this disease, which can have severe — and sometimes fatal consequences, said the reports lead author, Karen M. Puopolo, MD, PhD, a member of the AAP Committee on Fetus and Newborn. We know that by taking preventive steps during prenatal care, and by treating the mother with antibiotics during labor, we can prevent infection in babies. This is especially important for preterm babies who face higher risks.
  • #2 About Group B Strep Disease | Group B Strep | CDC
    https://www.cdc.gov/group-b-strep/about/index.html
    Healthcare providers usually treat GBS disease with antibiotics. […] Sometimes people with soft tissue and bone infections may need additional treatment, such as surgery. […] Treatment will depend on the type of infection caused by the GBS bacteria. […] It’s important to start treatment as soon as possible.
  • #2 Group B Streptococcus (GBS) Infections: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/229091-overview
    GBS infection is primarily managed with antibiotics, including the following: […] Penicillin G: Drug of choice for GBS infection […] Ampicillin: Another drug of choice for GBS infection […] Vancomycin: Initial treatment of choice for GBS infection in patients who are allergic to penicillin (owing to possible resistance to clindamycin) […] Penicillin, ampicillin, or vancomycin: Treatment of choice for endocarditis […] Clindamycin: Sensitivity testing must be done because of increasing resistance; oral clindamycin remains an excellent agent to follow a course of parenteral therapy for bone, soft-tissue, and lung infections, if the isolate is susceptible […] Cefazolin or ceftriaxone: Alternative to penicillin for GBS infection; not effective for GBS meningitis […] If none of the listed antibiotics can be used, a consultation with an infectious diseases specialist is strongly recommended.
  • #2 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    The initial therapy for suspected neonatal sepsis is ampicillin and an aminoglycoside, typically gentamicin. Both ampicillin and gentamicin have activity against GBS, which is the most common cause of neonatal sepsis. Additionally, this combination has a synergistic effect and is more effective than either ampicillin or penicillin G alone in killing most GBS strains in vitro and in vivo. Following confirmation of GBS as the causative pathogen, sterility of the bloodstream and cerebrospinal fluid (CSF) are documented, and clinical improvement is observed; penicillin G alone should be used to complete therapy. Recommendations concerning the optimal dose and duration of treatment should be dictated by the focus and severity of the infection.[14] […] Infants with GBS meningitis should undergo a second lumbar puncture 1 to 2 days into therapy to document CSF sterility. If CSF culture is negative, treatment therapy can be completed using penicillin G alone for a minimum of 14 days. If CSF culture remains positive, however, a longer treatment course and diagnostic evaluation may be warranted. A contrast-enhanced neuroimaging study can help reveal unresolved cerebritis cases or ventriculitis and can identify the rare infant with complications of subdural empyema or intracranial abscess. Additionally, imaging may identify cerebrovascular complications such as septic thrombophlebitis that can also affect the prognosis. A repeat lumbar puncture should be considered at the completion of therapy to evaluate CSF cell count and protein. Findings of polymorphonuclear cells greater than 30% or protein higher than 200 mg/dL are consistent with cerebritis or parenchymal destruction and may warrant a longer therapy duration. All infants recovering from GBS meningitis should undergo a diagnostic auditory brainstem response (ABR) test.
  • #2 Group B Streptococcus (Streptococcus agalactiae)
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6432937/
    Once GBS is isolated, penicillin G monotherapy is recommended for treatment of invasive GBS infection in infants. […] Recommended dosing of penicillin G for infants up to 7 days of age is 250,000 to 450,000 units/kg/day and 450,000 to 500,000 units/kg/day for infants older than 7 days. […] Ten days of appropriate therapy is recommended for uncomplicated bacteremia and 14 days for uncomplicated meningitis, while complicated infections may require a longer duration of antimicrobial therapy. […] Septic arthritis or osteomyelitis is treated for 3 to 4 weeks, and at least 4 weeks of therapy is recommended for endocarditis or ventriculitis.
  • #2 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    Intrapartum antibiotic prophylaxis (IAP) is indicated for all mothers with a positive GBS screening culture routinely obtained at 35 to 37 weeks gestation. Revised guidelines from 2010 also recommend IAP for pregnant women who have a history of GBS bacteriuria at any point during the current pregnancy or have a history of a previous infant with invasive GBS disease. In pregnant women with unknown GBS status, IAP is indicated if any of the following risk factors are present: (1) preterm delivery less than 37 weeks gestation, (2) membrane rupture for 18 hours or greater, (3) an intrapartum temperature of 100.4 F or higher, or (4) intrapartum nucleic acid amplification test (NAAT) is positive. […] Prophylaxis with a beta-lactam antibiotic (preferably penicillin) given four or more hours before delivery is highly effective for early-onset disease prevention. The initial dose of penicillin G is 5 million units, followed by subsequent doses of 2.5 to 3.0 million units every 4 hours until delivery. Alternatively, patients may instead receive ampicillin, 2 g IV initial dose, then 1 g IV every 4 hours until delivery.
  • #2 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    The definition of adequate IAP is administering penicillin, ampicillin, or cefazolin at least 4 hours before delivery.[16] All other medications, doses, or durations are considered inadequate for purposes of neonatal management. Women allergic to penicillin who do not have a history of anaphylaxis, angioedema, respiratory distress, or urticaria after administering penicillin or a cephalosporin should receive cefazolin (2 g initially and 1 g every 8 hours until delivery). For women with severe penicillin allergy (anaphylaxis, angioedema, respiratory distress, or urticaria), susceptibility testing should be performed, and clindamycin (900 mg every 8 hours until delivery) or vancomycin (1 g every 12 hours until delivery) can be given to based on susceptibility patterns of the isolated GBS organism. Furthermore, neither clindamycin IAP nor vancomycin IAP has been evaluated for efficacy in preventing early-onset GBS neonatal disease.
  • #2 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    Infants with bacteremia without focus should receive a total of a 10-day course of IV antibiotics. Relapses, although rare, have been documented if utilizing shorter courses. Oral therapy is not sufficient and has no place in the management of invasive GBS disease. The treatment duration for patients with septic arthritis, osteomyelitis, or endocarditis appears in the table. […] The recurrence rate for early-onset GBS disease is approximately 1%. Although rare, recurrence can be due to inadequate dose or duration of therapy, reinfection with a second strain or type, supportive foci, HIV infection, or a humoral immune deficiency. Humoral immune deficiency may be too early to diagnose definitively; however, total IgG levels are usually significantly lower than expected for the patients age. Furthermore, susceptibility testing from the first infection and the recurrent episode should be analyzed to ensure in vitro susceptibility to penicillin. If the reason for the recurrence remains unknown, persistent mucous membrane colonization with GBS is the likely source. Beta-lactam antibiotics, even when administered by the parenteral route, do not eradicate GBS colonization reliably. Some studies have shown the benefit of rifampin (20 mg/kg per day) to eradicate mucosal GBS colonization when given orally during the last four days of parenteral therapy. However, a more recent study showed a failure of rifampin to eradicate GBS colonization in infants reliably.[15]
  • #2 Group B Streptococcus (GBS) Infections Treatment & Management: Medical Care, Surgical Care, Consultations
    https://emedicine.medscape.com/article/229091-treatment
    Therefore, sensitivity testing should be done before these agents are used. Oral clindamycin remains an excellent agent for use after a course of parenteral therapy for bone, soft-tissue, and lung infections, if the isolate is susceptible. […] Because of possible resistance to clindamycin, vancomycin remains the initial treatment of choice for GBS infection in patients who are allergic to penicillin. Penicillin, ampicillin, and vancomycin remain the treatments of choice for endocarditis. […] In general, if ampicillin, penicillin, vancomycin, or ceftriaxone cannot be used, consultation with an infectious diseases specialist is strongly recommended. […] Consultation with a surgeon and surgical intervention are important. […] Patients with soft-tissue infection, septic arthritis, osteomyelitis, diskitis, and epidural abscess caused by GBS infection often require surgery combined with parenteral antibiotic therapy for resolution.
  • #2 Group B Streptococcus (GBS) Infections: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/229091-overview
    Although medical therapy should resolve many GBS infections, those involving skin, soft tissue, and bone may not be resolved with antibiotics alone and may require surgical intervention, including the following infections: […] Surgical emergencies: Necrotizing fasciitis, septic arthritis, and epidural abscess […] Empyema drainage in cases of pneumonia […] Heart valve replacement in patients with endocarditis, bacteremia, or sepsis […] Surgery plus parenteral antibiotics for soft-tissue infection, septic arthritis, osteomyelitis, diskitis, and epidural abscess […] Intervention for relief of genitourinary obstruction in patients with urinary tract infections […] Drainage for pelvic abscesses.
  • #2 Group B Streptococcus (GBS) Infections Treatment & Management: Medical Care, Surgical Care, Consultations
    https://emedicine.medscape.com/article/229091-treatment
    Various consultations may be required for optimal outcomes in patients with GBS infection. An infectious diseases specialist can often be helpful in choosing the antibiotic and duration of therapy, especially if the susceptibility report shows resistance to penicillins, vancomycin, and cephalosporins.
  • #2 Group B strep disease – Diagnosis & treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/group-b-strep/diagnosis-treatment/drc-20351735
    If your baby tests positive for group B strep, the baby receives IV antibiotics through a vein. Depending on your baby’s condition, the baby might need IV fluids, oxygen or other medicines. […] Antibiotics can treat group B strep infection in adults. The choice of antibiotic depends on the location and extent of the infection. It also depends on your specific circumstances. […] If you’re pregnant and you have medical problems because of group B strep, you’ll likely receive antibiotics by mouth. Most often, you’ll be given penicillin, amoxicillin (Amoxil, Larotid) or cephalexin. All are considered safe to take during pregnancy.
  • #2 Clinical Overview of Group B Strep Disease | Group B Strep | CDC
    https://www.cdc.gov/group-b-strep/hcp/clinical-overview/index.html
    Help prevent early-onset GBS disease through intrapartum antibiotic prophylaxis. […] Early-onset GBS disease can be prevented through intrapartum antibiotic prophylaxis. However, no effective strategy has yet been identified for how to prevent late-onset disease or adult disease. […] There has been widespread use of intrapartum antibiotic prophylaxis to prevent early-onset GBS disease.
  • #2 Group B streptococcus (GBS) – screening and management | Safer Care Victoria
    https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/maternity/group-b-streptococcus-gbs-screening-and-management
    Antibiotic prophylaxis is not recommended prior to the onset of labour. […] Recommend IAP to women with identified risk factors when active labour is identified: Intrapartum antibiotic prophylaxis flowchart. […] Adequate prophylaxis is considered to be commenced at least four hours prior to birth. […] Benzylpenicillin is the antibiotic of choice – IV penicillin and ampicillin are equally effective against GBS, but penicillin is preferable due to its narrower spectrum of activity. […] A GBS positive screening result is not a preclusion to labour in the bath or pool, or birth through water, as long as antibiotic prophylaxis occurs. […] Treat all unwell babies for suspected sepsis, irrespective of maternal GBS status or adequate IAP.
  • #2 Prevention of Perinatal Group B Streptococcal Disease: Updated CDC Guideline | AAFP
    https://www.aafp.org/pubs/afp/issues/2012/0701/p59.html
    Penicillin or ampicillin should be administered intravenously for intrapartum chemoprophylaxis against neonatal group B streptococcal infection. Cefazolin is an alternative in women with penicillin allergy who do not have a high risk of anaphylaxis. […] The recommended approach for antibiotic dosing is shown in […] Penicillin is the recommended antibiotic for intrapartum chemoprophylaxis of group B streptococcal disease; ampicillin is an acceptable alternative. […] The new guideline clarifies that women who are allergic to penicillin are at risk of anaphylaxis if they have a history of anaphylaxis, angioedema, respiratory distress, or urticaria after administration of penicillin or a cephalosporin. […] Clindamycin (900 mg intravenously every eight hours until delivery) is the drug of choice if the GBS isolate is susceptible to clindamycin and erythromycin, and if there is no inducible clindamycin resistance. Vancomycin (1 g intravenously every 12 hours until delivery) is recommended if testing shows resistance or inducible resistance to clindamycin. […] The new guideline defines inadequate intrapartum chemoprophylaxis as failure to receive at least four hours of intravenous penicillin, ampicillin, or cefazolin before delivery.
  • #2 Patient education: Group B streptococcus and pregnancy (Beyond the Basics) – UpToDate
    https://www.uptodate.com/contents/group-b-streptococcus-and-pregnancy-beyond-the-basics/print
    Newborn GBS infection and infection of the uterus after delivery can usually be prevented by giving an intravenous (IV) antibiotic during labor to anyone who is a GBS carrier when giving birth. […] If you are found to have GBS during pregnancy, even if you have no symptoms of infection, you will receive intravenous (IV) antibiotics during labor to significantly lower the risk of passing the bacteria on to your newborn. […] Being treated with an antibiotic during labor greatly reduces the chance that you or your newborn will develop a serious infection related to GBS in the first week after birth. […] Penicillin is the antibiotic typically used in this situation, although another antibiotic may be used if you have a penicillin allergy. […] If you go into preterm labor — If you go into preterm (premature) labor before you’ve been tested to find out if you carry GBS, a swab culture or NAAT will be done when you are admitted to the hospital. Then you will be treated with an IV antibiotic until your baby is born or the labor is stopped by your health care provider or labor stops on its own.
  • #2 Group B Strep in Pregnancy
    https://patient.info/pregnancy/strep-b-in-pregnancy
    If your baby has GBS infection, early diagnosis and treatment are essential as any delay can be very serious or even fatal. If your baby becomes very unwell or develops any signs that suggest possible GBS infection, they should be treated with antibiotics straightaway. […] Most early-onset GBS infections (in babies aged 0-6 days) can be prevented by giving intravenous antibiotics during labour to women whose babies are at particular risk of GBS infection: […] If GBS is found in your urine then you will need antibiotics, as soon as it is diagnosed, to treat your urinary tract infection. You will also be offered antibiotics through a drip during labour to prevent GBS infection in your baby. […] Babies with signs of GBS infection or babies who are suspected to have the infection should be treated with antibiotics as soon as possible. Treatment will be stopped if there is no sign of infection after at least 36 hours, and all the tests are negative.
  • #2 Group B Streptococcus Disease: AAP Updates Guidelines for the Management of At-Risk Infants | AAFP
    https://www.aafp.org/pubs/afp/issues/2020/0315/p378.html
    If early-onset GBS disease is highly suspected, a lumbar puncture and analysis of cerebrospinal fluid should be performed. […] Ampicillin with an aminoglycoside is recommended for infants up to seven days of age. […] Without signs of meningitis or severe illness, ampicillin and ceftazidime (Fortaz) are recommended for infants eight to 28 days of age and ceftriaxone (Rocephin) is recommended for infants 29 to 90 days of age. […] Vancomycin may be added to these treatments when there is evidence of meningitis or to expand the coverage in critically ill patients.
  • #2 Group B Streptococcus | Children’s Hospital of Philadelphia
    https://www.chop.edu/conditions-diseases/group-b-streptococcus
    Treatment of GBS depends on when GBS infection is diagnosed — during pregnancy or after delivery. Specific treatment for GBS will be determined by your physician based on: […] If the mother has a positive GBS culture during pregnancy, the CDC and the American College of Obstetricians and Gynecologists recommend treatment with intravenous (IV) antibiotics during labor to reduce the risk of transmission of the infection to the baby. Penicillin is the most common antibiotic that is given. […] Newborns who become ill with GBS infection may require care in the newborn intensive care unit (NICU). They are usually treated with IV antibiotics. Other treatments and specialized care may be needed depending on the severity of the infection and whether the infection causes serious problems such as meningitis or pneumonia.
  • #2
    https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/group-b-streptococcus-(gbs)
    Streptococcus agalactiae (Group B streptococcus or GBS) is a leading cause of neonatal and infant sepsis and meningitis globally. […] Administration of intrapartum antibiotic prophylaxis (IAP) to pregnant women with GBS colonization can substantially reduce the incidence of early-onset GBS disease, but IAP does not prevent late-onset GBS disease, which in most cases are transmitted postnatally. […] An effective maternal GBS vaccine targeting pregnant women offers the potential to protect infants against both early- and late-onset GBS disease through transplacental transfer of maternal antibodies, and reduce disease burden worldwide. […] The development of Group B Streptococcus (GBS) vaccines for maternal immunization has been identified by the Product Development for Vaccines Advisory Committee (PDVAC) as a priority, because of the major public health burden posed by GBS in LMIC.
  • #2
    https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/group-b-streptococcus-(gbs)
    The strategic goal for GBS vaccines is to develop and license safe, effective and affordable GBS vaccines for maternal immunization during pregnancy to prevent GBS-related stillbirth and invasive GBS disease in neonates and young infants, appropriate for use in high-, middle- and low-income countries. […] Efficacy studies for GBS vaccine will require a large number of participants, therefore initial vaccine licensure based on immunological correlates of protection (CoP) should be explored, followed by post licensure studies to assess effectiveness and to evaluate the reduction in disease burden.
  • #2 Clinical Characteristics and Treatment Strategies for Group B Streptococcus (GBS) Infection in Pediatrics: A Systematic Review
    https://www.mdpi.com/1648-9144/59/7/1279
    However, concerns have been raised regarding the overuse of antibiotics, which can lead to the development of antibiotic-resistant strains of bacteria. […] Intravenous immunoglobulin (IVIG) is an alternative treatment strategy that has been proposed for GBS infection in pediatrics. […] IVIG has been shown to be effective in reducing the risk of GBS infection in neonates and improving outcomes in infants with GBS infection. […] However, IVIG is expensive and not widely available, and there are limited data on its long-term safety. […] Supportive care is important to stabilize the infant’s condition and manage any complications that may arise. […] The review will consider studies that evaluate the efficacy and safety of prophylactic antibiotics, IVIG, and supportive care in the treatment of GBS infection in pediatrics. […] This review will also assess the impact of these treatments on long-term outcomes, such as neurodevelopmental outcomes and the development of antibiotic resistance.
  • #2 Natural and Integrative Treatments for Group B Strep in Women
    https://naturemed.org/natural-and-integrative-treatments-for-group-b-strep-in-women/
    Compounds isolated from raw garlic may have antimicrobial properties for GBS (however, do not self-administer raw garlic or other forms of garlic as a treatment as further research needs to be done to determine the most appropriate method of administration to effectively prevent the transmission of GBS to a newborn). […] Probiotics, including specialized Bifidobacterium and Lactobacillus strains, can help restore the balance of gut bacteria and may allow the doctor to reduce the required dosage of antibiotics.
  • #2 Natural and Integrative Treatments for Group B Strep in Women
    https://naturemed.org/natural-and-integrative-treatments-for-group-b-strep-in-women/
    If you are testing positive for GBS, ask your physician to do susceptibility and allergy testing for specific oral antibiotics first, like penicillin, as IV antibiotics will likely be administered during labor to reduce the risk of transmission to the baby. […] Timely administration of IV antibiotics by an attending physician or healthcare provider can significantly reduce the risk of transmission of bacterial infection to the baby and prevent serious infections. […] Intravenous antibiotics are the first course of antibiotic treatment, though naturopathic doctors may offer other therapies to support the body. These natural remedies include probiotics, herbs and supplements, and dietary modifications. […] If a woman suspects they have a GBS infection, a naturopathic physician (ND) will use antibiotics and a combination of integrative treatments, depending on the situation. It is imperative to protect the health of the woman and fetus; therefore, home remedies alone are insufficient to address this conditions complexity and severity.
  • #2 Group B streptococcal infection – Symptoms, diagnosis and treatment | BMJ Best Practice
    https://bestpractice.bmj.com/topics/en-gb/924
    Targeted antibiotic therapy is the mainstay of therapy in patients with confirmed GBS infection. […] This topic deals with confirmed group B streptococcal infection only.
  • #2 Prevention of Group B Streptococcal Early-Onset Disease in Newborns | ACOG
    https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns
    Targeted intravenous intrapartum antibiotic prophylaxis has demonstrated efficacy for prevention of GBS early-onset disease (EOD) in neonates born to women with positive antepartum GBS cultures and women who have other risk factors for intrapartum GBS colonization. Neither antepartum nor intrapartum oral or intramuscular regimens have been shown to be comparably effective in reducing GBS EOD. […] All women whose vaginalrectal cultures at 36 0/737 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes. […] If the prenatal GBS culture result is unknown when labor starts, intrapartum antibiotic prophylaxis is indicated for women who have risk factors for GBS EOD.
  • #2
    https://www.healthychildren.org/English/news/Pages/AAP-Updates-Guidance-on-Infants-With-Group-B-Strep-Disease.aspx
    Both groups support universal maternal screening and when appropriate, antibiotics to prevent transmission of Group B streptococcal bacteria from mother to infant before or during delivery. […] Administering antibiotic during childbirth, when indicated and as recommended by the American College of Obstetricians and Gynecologists, to protect the newborn from transmission of Group B streptococcal bacteria. […] Updated dosing recommendations for treatment of neonatal and infant Group B streptococcal disease. The preferred antibiotic for confirmed GBS disease in infants is penicillin G, followed by ampicillin. […] We hope to identify more ways to prevent these infections, such as a vaccine that could be used worldwide, Dr. Puopolo said. These guidelines are the most effective tool we have right now to protect infants and save lives.
  • #3 Group B Streptococcus (Streptococcus agalactiae)
    https://pmc.ncbi.nlm.nih.gov/articles/PMC6432937/
    Penicillin G remains the mainstay of therapy, although reduced penicillin susceptibility has been observed in select isolates. […] In patients who demonstrate an anaphylactic or severe allergy to beta-lactam antimicrobials, alternative therapies include clindamycin, erythromycin, fluoroquinolones, and vancomycin. […] Penicillin G is the first-line treatment for invasive GBS disease in adults. […] The duration of therapy depends on the clinical presentation. […] Ten days of therapy is generally acceptable for bacteremia, pneumonia, pyelonephritis, and skin/soft tissue infections. […] Longer durations of treatment are recommended for meningitis (minimum 14 days) and for osteomyelitis, endocarditis, and ventriculitis (minimum 4 weeks). […] In neonates with presumptive EOD, empiric therapy with ampicillin combined with an aminoglycoside is the standard of care.
  • #3 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    The initial therapy for suspected neonatal sepsis is ampicillin and an aminoglycoside, typically gentamicin. Both ampicillin and gentamicin have activity against GBS, which is the most common cause of neonatal sepsis. Additionally, this combination has a synergistic effect and is more effective than either ampicillin or penicillin G alone in killing most GBS strains in vitro and in vivo. Following confirmation of GBS as the causative pathogen, sterility of the bloodstream and cerebrospinal fluid (CSF) are documented, and clinical improvement is observed; penicillin G alone should be used to complete therapy. Recommendations concerning the optimal dose and duration of treatment should be dictated by the focus and severity of the infection.[14] […] Infants with GBS meningitis should undergo a second lumbar puncture 1 to 2 days into therapy to document CSF sterility. If CSF culture is negative, treatment therapy can be completed using penicillin G alone for a minimum of 14 days. If CSF culture remains positive, however, a longer treatment course and diagnostic evaluation may be warranted. A contrast-enhanced neuroimaging study can help reveal unresolved cerebritis cases or ventriculitis and can identify the rare infant with complications of subdural empyema or intracranial abscess. Additionally, imaging may identify cerebrovascular complications such as septic thrombophlebitis that can also affect the prognosis. A repeat lumbar puncture should be considered at the completion of therapy to evaluate CSF cell count and protein. Findings of polymorphonuclear cells greater than 30% or protein higher than 200 mg/dL are consistent with cerebritis or parenchymal destruction and may warrant a longer therapy duration. All infants recovering from GBS meningitis should undergo a diagnostic auditory brainstem response (ABR) test.
  • #3 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    Intrapartum antibiotic prophylaxis (IAP) is indicated for all mothers with a positive GBS screening culture routinely obtained at 35 to 37 weeks gestation. Revised guidelines from 2010 also recommend IAP for pregnant women who have a history of GBS bacteriuria at any point during the current pregnancy or have a history of a previous infant with invasive GBS disease. In pregnant women with unknown GBS status, IAP is indicated if any of the following risk factors are present: (1) preterm delivery less than 37 weeks gestation, (2) membrane rupture for 18 hours or greater, (3) an intrapartum temperature of 100.4 F or higher, or (4) intrapartum nucleic acid amplification test (NAAT) is positive. […] Prophylaxis with a beta-lactam antibiotic (preferably penicillin) given four or more hours before delivery is highly effective for early-onset disease prevention. The initial dose of penicillin G is 5 million units, followed by subsequent doses of 2.5 to 3.0 million units every 4 hours until delivery. Alternatively, patients may instead receive ampicillin, 2 g IV initial dose, then 1 g IV every 4 hours until delivery.
  • #3 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    The definition of adequate IAP is administering penicillin, ampicillin, or cefazolin at least 4 hours before delivery.[16] All other medications, doses, or durations are considered inadequate for purposes of neonatal management. Women allergic to penicillin who do not have a history of anaphylaxis, angioedema, respiratory distress, or urticaria after administering penicillin or a cephalosporin should receive cefazolin (2 g initially and 1 g every 8 hours until delivery). For women with severe penicillin allergy (anaphylaxis, angioedema, respiratory distress, or urticaria), susceptibility testing should be performed, and clindamycin (900 mg every 8 hours until delivery) or vancomycin (1 g every 12 hours until delivery) can be given to based on susceptibility patterns of the isolated GBS organism. Furthermore, neither clindamycin IAP nor vancomycin IAP has been evaluated for efficacy in preventing early-onset GBS neonatal disease.
  • #3 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    Infants with bacteremia without focus should receive a total of a 10-day course of IV antibiotics. Relapses, although rare, have been documented if utilizing shorter courses. Oral therapy is not sufficient and has no place in the management of invasive GBS disease. The treatment duration for patients with septic arthritis, osteomyelitis, or endocarditis appears in the table. […] The recurrence rate for early-onset GBS disease is approximately 1%. Although rare, recurrence can be due to inadequate dose or duration of therapy, reinfection with a second strain or type, supportive foci, HIV infection, or a humoral immune deficiency. Humoral immune deficiency may be too early to diagnose definitively; however, total IgG levels are usually significantly lower than expected for the patients age. Furthermore, susceptibility testing from the first infection and the recurrent episode should be analyzed to ensure in vitro susceptibility to penicillin. If the reason for the recurrence remains unknown, persistent mucous membrane colonization with GBS is the likely source. Beta-lactam antibiotics, even when administered by the parenteral route, do not eradicate GBS colonization reliably. Some studies have shown the benefit of rifampin (20 mg/kg per day) to eradicate mucosal GBS colonization when given orally during the last four days of parenteral therapy. However, a more recent study showed a failure of rifampin to eradicate GBS colonization in infants reliably.[15]
  • #3 Group B Streptococcus (GBS) Infections Treatment & Management: Medical Care, Surgical Care, Consultations
    https://emedicine.medscape.com/article/229091-treatment
    Therefore, sensitivity testing should be done before these agents are used. Oral clindamycin remains an excellent agent for use after a course of parenteral therapy for bone, soft-tissue, and lung infections, if the isolate is susceptible. […] Because of possible resistance to clindamycin, vancomycin remains the initial treatment of choice for GBS infection in patients who are allergic to penicillin. Penicillin, ampicillin, and vancomycin remain the treatments of choice for endocarditis. […] In general, if ampicillin, penicillin, vancomycin, or ceftriaxone cannot be used, consultation with an infectious diseases specialist is strongly recommended. […] Consultation with a surgeon and surgical intervention are important. […] Patients with soft-tissue infection, septic arthritis, osteomyelitis, diskitis, and epidural abscess caused by GBS infection often require surgery combined with parenteral antibiotic therapy for resolution.
  • #3 Group B streptococcus (GBS) – screening and management | Safer Care Victoria
    https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/maternity/group-b-streptococcus-gbs-screening-and-management
    Antibiotic prophylaxis is not recommended prior to the onset of labour. […] Recommend IAP to women with identified risk factors when active labour is identified: Intrapartum antibiotic prophylaxis flowchart. […] Adequate prophylaxis is considered to be commenced at least four hours prior to birth. […] Benzylpenicillin is the antibiotic of choice – IV penicillin and ampicillin are equally effective against GBS, but penicillin is preferable due to its narrower spectrum of activity. […] A GBS positive screening result is not a preclusion to labour in the bath or pool, or birth through water, as long as antibiotic prophylaxis occurs. […] Treat all unwell babies for suspected sepsis, irrespective of maternal GBS status or adequate IAP.
  • #3 Group B Streptococcus Disease: AAP Updates Guidelines for the Management of At-Risk Infants | AAFP
    https://www.aafp.org/pubs/afp/issues/2020/0315/p378.html
    If early-onset GBS disease is highly suspected, a lumbar puncture and analysis of cerebrospinal fluid should be performed. […] Ampicillin with an aminoglycoside is recommended for infants up to seven days of age. […] Without signs of meningitis or severe illness, ampicillin and ceftazidime (Fortaz) are recommended for infants eight to 28 days of age and ceftriaxone (Rocephin) is recommended for infants 29 to 90 days of age. […] Vancomycin may be added to these treatments when there is evidence of meningitis or to expand the coverage in critically ill patients.
  • #3 Clinical Characteristics and Treatment Strategies for Group B Streptococcus (GBS) Infection in Pediatrics: A Systematic Review
    https://www.mdpi.com/1648-9144/59/7/1279
    However, concerns have been raised regarding the overuse of antibiotics, which can lead to the development of antibiotic-resistant strains of bacteria. […] Intravenous immunoglobulin (IVIG) is an alternative treatment strategy that has been proposed for GBS infection in pediatrics. […] IVIG has been shown to be effective in reducing the risk of GBS infection in neonates and improving outcomes in infants with GBS infection. […] However, IVIG is expensive and not widely available, and there are limited data on its long-term safety. […] Supportive care is important to stabilize the infant’s condition and manage any complications that may arise. […] The review will consider studies that evaluate the efficacy and safety of prophylactic antibiotics, IVIG, and supportive care in the treatment of GBS infection in pediatrics. […] This review will also assess the impact of these treatments on long-term outcomes, such as neurodevelopmental outcomes and the development of antibiotic resistance.
  • #4 Group B Streptococcus (GBS) Infections Treatment & Management: Medical Care, Surgical Care, Consultations
    https://emedicine.medscape.com/article/229091-treatment
    Group B streptococci are likely to be sensitive to penicillin and ampicillin. However, resistance to penicillin (and beta-lactams in general) has been increasing, as documented in studies done in the United States, Hong Kong, and Japan. Group B streptococci have never been as sensitive to penicillin as group A -hemolytic streptococci; therefore, the initial therapy for GBS infection has always been high-dose parenteral penicillin or ampicillin. Cephalosporins, such as cefazolin and ceftriaxone, can often be used for the treatment of penicillin-sensitive infections. […] Although clindamycin and erythromycin were at one time uniformly active against group B streptococci, resistance has been increasing. One large study that examined the susceptibility patterns of more than 4800 GBS isolates showed that 32% were resistant to erythromycin and 15% were resistant to clindamycin and that 99% of clindamycin-resistant strains were also resistant to erythromycin.
  • #4 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    The initial therapy for suspected neonatal sepsis is ampicillin and an aminoglycoside, typically gentamicin. Both ampicillin and gentamicin have activity against GBS, which is the most common cause of neonatal sepsis. Additionally, this combination has a synergistic effect and is more effective than either ampicillin or penicillin G alone in killing most GBS strains in vitro and in vivo. Following confirmation of GBS as the causative pathogen, sterility of the bloodstream and cerebrospinal fluid (CSF) are documented, and clinical improvement is observed; penicillin G alone should be used to complete therapy. Recommendations concerning the optimal dose and duration of treatment should be dictated by the focus and severity of the infection.[14] […] Infants with GBS meningitis should undergo a second lumbar puncture 1 to 2 days into therapy to document CSF sterility. If CSF culture is negative, treatment therapy can be completed using penicillin G alone for a minimum of 14 days. If CSF culture remains positive, however, a longer treatment course and diagnostic evaluation may be warranted. A contrast-enhanced neuroimaging study can help reveal unresolved cerebritis cases or ventriculitis and can identify the rare infant with complications of subdural empyema or intracranial abscess. Additionally, imaging may identify cerebrovascular complications such as septic thrombophlebitis that can also affect the prognosis. A repeat lumbar puncture should be considered at the completion of therapy to evaluate CSF cell count and protein. Findings of polymorphonuclear cells greater than 30% or protein higher than 200 mg/dL are consistent with cerebritis or parenchymal destruction and may warrant a longer therapy duration. All infants recovering from GBS meningitis should undergo a diagnostic auditory brainstem response (ABR) test.
  • #4 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    Intrapartum antibiotic prophylaxis (IAP) is indicated for all mothers with a positive GBS screening culture routinely obtained at 35 to 37 weeks gestation. Revised guidelines from 2010 also recommend IAP for pregnant women who have a history of GBS bacteriuria at any point during the current pregnancy or have a history of a previous infant with invasive GBS disease. In pregnant women with unknown GBS status, IAP is indicated if any of the following risk factors are present: (1) preterm delivery less than 37 weeks gestation, (2) membrane rupture for 18 hours or greater, (3) an intrapartum temperature of 100.4 F or higher, or (4) intrapartum nucleic acid amplification test (NAAT) is positive. […] Prophylaxis with a beta-lactam antibiotic (preferably penicillin) given four or more hours before delivery is highly effective for early-onset disease prevention. The initial dose of penicillin G is 5 million units, followed by subsequent doses of 2.5 to 3.0 million units every 4 hours until delivery. Alternatively, patients may instead receive ampicillin, 2 g IV initial dose, then 1 g IV every 4 hours until delivery.
  • #4 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    The definition of adequate IAP is administering penicillin, ampicillin, or cefazolin at least 4 hours before delivery.[16] All other medications, doses, or durations are considered inadequate for purposes of neonatal management. Women allergic to penicillin who do not have a history of anaphylaxis, angioedema, respiratory distress, or urticaria after administering penicillin or a cephalosporin should receive cefazolin (2 g initially and 1 g every 8 hours until delivery). For women with severe penicillin allergy (anaphylaxis, angioedema, respiratory distress, or urticaria), susceptibility testing should be performed, and clindamycin (900 mg every 8 hours until delivery) or vancomycin (1 g every 12 hours until delivery) can be given to based on susceptibility patterns of the isolated GBS organism. Furthermore, neither clindamycin IAP nor vancomycin IAP has been evaluated for efficacy in preventing early-onset GBS neonatal disease.
  • #4 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    Infants with bacteremia without focus should receive a total of a 10-day course of IV antibiotics. Relapses, although rare, have been documented if utilizing shorter courses. Oral therapy is not sufficient and has no place in the management of invasive GBS disease. The treatment duration for patients with septic arthritis, osteomyelitis, or endocarditis appears in the table. […] The recurrence rate for early-onset GBS disease is approximately 1%. Although rare, recurrence can be due to inadequate dose or duration of therapy, reinfection with a second strain or type, supportive foci, HIV infection, or a humoral immune deficiency. Humoral immune deficiency may be too early to diagnose definitively; however, total IgG levels are usually significantly lower than expected for the patients age. Furthermore, susceptibility testing from the first infection and the recurrent episode should be analyzed to ensure in vitro susceptibility to penicillin. If the reason for the recurrence remains unknown, persistent mucous membrane colonization with GBS is the likely source. Beta-lactam antibiotics, even when administered by the parenteral route, do not eradicate GBS colonization reliably. Some studies have shown the benefit of rifampin (20 mg/kg per day) to eradicate mucosal GBS colonization when given orally during the last four days of parenteral therapy. However, a more recent study showed a failure of rifampin to eradicate GBS colonization in infants reliably.[15]
  • #4 Group B Streptococcus Disease: AAP Updates Guidelines for the Management of At-Risk Infants | AAFP
    https://www.aafp.org/pubs/afp/issues/2020/0315/p378.html
    If early-onset GBS disease is highly suspected, a lumbar puncture and analysis of cerebrospinal fluid should be performed. […] Ampicillin with an aminoglycoside is recommended for infants up to seven days of age. […] Without signs of meningitis or severe illness, ampicillin and ceftazidime (Fortaz) are recommended for infants eight to 28 days of age and ceftriaxone (Rocephin) is recommended for infants 29 to 90 days of age. […] Vancomycin may be added to these treatments when there is evidence of meningitis or to expand the coverage in critically ill patients.
  • #5 Group B Streptococcus (GBS) Infections: Practice Essentials, Background, Pathophysiology
    https://emedicine.medscape.com/article/229091-overview
    GBS infection is primarily managed with antibiotics, including the following: […] Penicillin G: Drug of choice for GBS infection […] Ampicillin: Another drug of choice for GBS infection […] Vancomycin: Initial treatment of choice for GBS infection in patients who are allergic to penicillin (owing to possible resistance to clindamycin) […] Penicillin, ampicillin, or vancomycin: Treatment of choice for endocarditis […] Clindamycin: Sensitivity testing must be done because of increasing resistance; oral clindamycin remains an excellent agent to follow a course of parenteral therapy for bone, soft-tissue, and lung infections, if the isolate is susceptible […] Cefazolin or ceftriaxone: Alternative to penicillin for GBS infection; not effective for GBS meningitis […] If none of the listed antibiotics can be used, a consultation with an infectious diseases specialist is strongly recommended.
  • #5 Streptococcus Group B – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK553143/
    Intrapartum antibiotic prophylaxis (IAP) is indicated for all mothers with a positive GBS screening culture routinely obtained at 35 to 37 weeks gestation. Revised guidelines from 2010 also recommend IAP for pregnant women who have a history of GBS bacteriuria at any point during the current pregnancy or have a history of a previous infant with invasive GBS disease. In pregnant women with unknown GBS status, IAP is indicated if any of the following risk factors are present: (1) preterm delivery less than 37 weeks gestation, (2) membrane rupture for 18 hours or greater, (3) an intrapartum temperature of 100.4 F or higher, or (4) intrapartum nucleic acid amplification test (NAAT) is positive. […] Prophylaxis with a beta-lactam antibiotic (preferably penicillin) given four or more hours before delivery is highly effective for early-onset disease prevention. The initial dose of penicillin G is 5 million units, followed by subsequent doses of 2.5 to 3.0 million units every 4 hours until delivery. Alternatively, patients may instead receive ampicillin, 2 g IV initial dose, then 1 g IV every 4 hours until delivery.

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