Prophylaxis regimens for neonatal GBS disease
If indicated, start antibiotic prophylaxis for group B streptococcus (GBS) on admission to hospital for labour, induction of labour or rupture of membranes. Ideally, start prophylaxis at least 4 hours before delivery.
Evidence to guide dosing is limited; however, the recommended regimen is:
benzylpenicillin 3 g intravenously for the first dose, then 1.8 g intravenously, 4-hourly until delivery. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment. benzylpenicillin benzylpenicillin benzylpenicillin
For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use:
cefazolin 2 g intravenously, 8-hourly until delivery. For dosage adjustment in adults with kidney impairment, see cefazolin dosage adjustment. cefazolin cefazolin cefazolin
For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin, cefazolin (at the dosage above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).
For patients who have had a severe immediate1 hypersensitivity reaction to a penicillin in whom cefazolin is not used, or for patients who have had a severe delayed2 hypersensitivity reaction to a penicillin, a non–beta-lactam antibiotic is required; clindamycin or vancomycin can be used. Clindamycin is preferred to reduce the risk of antimicrobial resistance but group B streptococcus resistance to clindamycin is increasing; only use the following regimen if the isolate is susceptible to clindamycin:
clindamycin 600 mg intravenously, 8-hourly until delivery. clindamycin clindamycin clindamycin
If the group B streptococcus isolate is resistant to clindamycin, or the group B streptococcus status (or susceptibility) is unknown, for patients who require a non–beta-lactam regimen, use:
vancomycin intravenously, until delivery; see Intermittent vancomycin dosing in noncritically ill adults for initial dosing. vancomycin vancomycin vancomycin
Patients undergoing caesarean section require surgical prophylaxis (see Caesarean section for regimens). If the group B streptococcus prophylaxis regimen has an appropriate spectrum of activity for surgical prophylaxis, additional surgical prophylaxis is not required. However, adjust the timing of the dose to achieve adequate plasma and tissue concentrations at the time of surgical incision and for the duration of the procedure. See also Surgical antibiotic prophylaxis for patients receiving treatment for established infection.
If intra-amniotic infection (chorioamnionitis) is suspected or confirmed (ie fever [38°C or more] with other clinical manifestations such as uterine tenderness and purulent amniotic fluid), stop prophylaxis and treat as for Intra-amniotic infection (chorioamnionitis).