Table 47.9.

Intrapartum prophylaxis for prevention of early-onset GBS infection

Screen

▪All pregnant women between 35 and 37 weeks gestation, unless GBS bacteriuria has been detected

Treat

▪ Women whose culture results are unknown but who have risk factors: Delivery at <37 weeks gestation Prolonged membrane rupture >18 hours Maternal intrapartum temperature >38.0 °C ▪Women with GBS bacteriuria during the current pregnancy ▪Women who previously gave birth to an infant with invasive GBS

Do not treat

▪ Women with negative cultures obtained during the 5 weeks prior to delivery • GBS-colonized women undergoing planned cesarean deliveries who have not begun labor or had rupture of membranes

Regimens

▪ Recommended • Penicillin G, 5 million units intravenously × 1 dose, followed by 2.5 million units intravenously every 4 hours until delivery ▪ Alternative • Ampicillin 2 g intravenously × 1 dose, followed by 1 g intravenously every 4 hours until delivery ▪ Penicillin allergy • Low risk for anaphylaxis: • Cefazolin 2 g intravenously × 1 dose, followed by 1 g intravenously every 8 hours until delivery • High risk for anaphylaxis: GBS susceptible to erythromycin • Erythromycin 500 mg intravenously every 6 hours until delivery GBS susceptible to clindamycin • Clindamycin 900 mg intravenously every 8 hours until delivery GBS resistant to erythromycin and clindamycin • Vancomycin 1 g intravenously every 12 hours until delivery

Adapted from CDC, Prevention of perinatal group B Streptococcal disease. MMWR 2002;51(RR11);1-22.