From the Guidelines
The treatment for Group B Streptococcus (GBS) urinary tract infection (UTI) during pregnancy should be according to current standards of care for urinary tract infections in pregnancy, and women with GBS bacteriuria should also receive intrapartum chemoprophylaxis. The presence of GBS bacteriuria is a marker for heavy genital tract colonization, and therefore, these women are at increased risk of delivering an infant with early-onset GBS disease 1.
Key Considerations
- Women with symptomatic or asymptomatic GBS urinary tract infection detected during pregnancy should be treated according to current standards of care for urinary tract infection during pregnancy 1.
- The treatment should be based on susceptibility testing to ensure proper antibiotic selection, as GBS can be resistant to some antibiotics 1.
- Intrapartum chemoprophylaxis should be given to all pregnant women identified as GBS carriers, including those with GBS bacteriuria, to prevent early-onset GBS disease in the newborn 1.
Treatment Options
- Penicillin is the preferred agent for intrapartum chemoprophylaxis, but alternatives such as ampicillin, cefazolin, clindamycin, or erythromycin may be used in patients with penicillin allergies 1.
- The regimen for intrapartum chemoprophylaxis includes penicillin G, 5 million units intravenously initial dose, then 2.5 million units intravenously every 4 hours until delivery, or ampicillin, 2 g intravenously initial dose, then 1 g intravenously every 4 hours until delivery 1.
Important Notes
- Women with GBS urinary tract infections during pregnancy should receive appropriate treatment at the time of diagnosis, as well as intrapartum GBS prophylaxis 1.
- Laboratory personnel should report any presence of GBS bacteriuria in specimens obtained from pregnant women, and labeling of urine specimens to indicate that they were obtained from a pregnant woman is imperative 1.
From the Research
Treatment for Group B Strep UTI
- The treatment for Group B strep UTI typically involves antibiotics, with the choice of antibiotic depending on the severity of the infection and the patient's underlying health conditions 2, 3, 4.
- For uncomplicated UTIs, empirical antibiotic therapy may be based on the clinical classification and risk factors, with the goal of using antibiotics with a narrow spectrum of activity and minimal collateral damage 5.
- For serious Group B strep infections, including UTIs, high doses of benzylpenicillin (penicillin G) are recommended due to the higher minimal inhibitory concentrations 2.
- Alternative antibiotics, such as vancomycin, ofloxacin, ampicillin, ciprofloxacin, and nitrofurantoin, may be considered for patients who are allergic to penicillin or have resistant strains of Group B strep 3.
- The antibiotic susceptibility profiles of Group B strep isolates should be determined to guide the selection of appropriate antibiotic therapy, especially in cases of complicated UTIs or antibiotic-resistant strains 3, 4.
Antibiotic Resistance and Treatment
- Group B strep isolates have shown resistance to various antibiotics, including azithromycin, ceftriaxone, clindamycin, and erythromycin 3, 4.
- The choice of antibiotic therapy should take into account the antibiotic resistance patterns of the local Group B strep isolates and the patient's individual risk factors 5.
- Nitrofurantoin may be a suitable option for treating Group B strep UTIs, especially in patients with bacteriuria 3.