Recommended Regimens for Intrapartum Antimicrobial Prophylaxis for Perinatal Group B Streptococcus (GBS) Disease Prevention

Adapted from:  CDC.  Prevention of perinatal group B streptococcal disease:  revised guidelines from CDC.  MMWR  2010;59(RR-10)

No History of Penicillin Allergy

Recommended

Penicillin G 5 million units IV initial dose, then 3 million units IV every 4 hours until delivery

Alternative

Ampicillin 2 g IV initial dose, then 1 g IV every 6 hours until delivery

History of Penicillin Allergy1,2

Reaction to penicillin is non-life threatening (i.e. rash)*

Cefazolin 2 g IV initial dose, then 1 g IV every 8 hours until delivery

Reaction to penicillin is immediate-type hypersensitivity and GBS is sensitive to erythromycin and clindamycin, or clindamycin alone3

Clindamycin 900 mg IV Q8 until delivery

 

Reaction to penicillin is immediate-type hypersensitivity and GBS is resistant to erythromycin and clindamycin or susceptibility is unknown

Vancomycin4 1 g IV every 12 hours until delivery

1  History of penicillin allergy should be assessed to determine whether the patient is at high risk for anaphylaxis.  Cefazolin should be avoided in patients with a history of immediate-type hypersensitivity reactions to penicillin (i.e. anaphylaxis, urticaria, angioedema).

2  Erythromycin and clindamycin susceptibility of GBS isolates should be requested in patients with immediate-type hypersensitivity to penicillin.  Specimens from patients with penicillin allergies should be labeled “patient allergic to penicillin” in order for susceptibility to be performed.

3  Check susceptibility results to determine if clindamycin can be used.  If the microbiology laboratory reports that the isolate is clindamycin susceptible (regardless of erythromycin result), then clindamycin can be used, as the HUP lab checks for inducible clindamycin resistance in erythromycin resistant isolates. 

4   The first dose of vancomycin will be available in the pyxis machine on Ravdin 7.  All subsequent doses of vancomycin MUST be approved by Infectious Diseases (215-306-0336).

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revised 10/18/10 pe