GBS Tx Criteria
How to Test:
  • Swab lower vagina (introitus) followed by rectum (insert swab into anus) using same swab.
  • Order susceptibility testing on isolates.

Treatment Criteria:

  1. (+) GBS at any time during pregnancy
  2. Pre-term labor (<34 weeks)
  3. Prolonged ROM ( >18hr)
  4. Fever (>100.4)
  5. Previous baby with GBS sepsis

NOTE:
• Women with negative GBS cultures within 5 weeks of delivery do not require antibiotics even if risk factors develop.
  – Delivery at < 37 weeks of gestation
  – Amniotic membrane rupture > 18 hours
  – Intra-partum temperature > 100.4 F (> 38.0 C)

Tx:
Pen G 5 million U IV, then 2.5 million U q4h

  • If allergic -- what is allergy?

    • Low Risk (rash)
      • Cefazolin 2g IV, then 1g q8h
    • High Risk (anaphylaxis)
      • Vancomycin 1g IV q12h unless GBS sensitive to clindamycin OR erythromycin are known.

Ideal IAP (intrapartum ABx Prophylaxysis):
- At least 2 doses of ABx prior to deliver.
Adequate IAP:
- 1 dose of ABx at least 4 hrs prior to delivery.
Inadequate IAP:
- 1 dose of ABx given < 4 hr before delivery.


NOT indicated for pregnant women with any of following:

  • (-) GBS.
  • Unknown GBS w/ NO intrapartum risk factors.
  • Planned C-Section w/o labor or ROM.

Antibiotic treatment prior to onset of labor or ROM to eradiate GBS is NOT indicated.

 


Baby of GBS (+) mother

(+) Signs of Sepsis Gest. age <37 wk
Adequate ABx (at least 4 hr prior to delivery)
> 37 wk
Inadequate ABx
- CBC, CMP
- Blood Cult
- CXR
- UA w/ Cult.
- LP
- +/- CRP
- CBC
- Blood Cult.
- +/- CRP
- Observe 48hrs
 
- Observe 48hrs
Empiric Rx:    
LP (-) LP(+)
-Amp/Gent - Rocephin

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