Back to Table of ContentsAdapted from: CDC. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR 2002;51(RR-11):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 4 hours until delivery |
History of Penicillin Allergy1,2 |
|
|
Reaction to penicillin is non-life threatening (i.e. rash)* |
Cefazolin 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 OR Erythromycin 500 mg IV Q6 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 erythromycin or clindamycin can be used. If the microbiology laboratory reports that the isolate is both erythromycin and clindamycin susceptible, then either agent can be used. If the isolate is reported as erythromycin resistant but clindamycin susceptible, then clindamycin may be used.
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).