From the Guidelines
Ceftriaxone is not the first-line treatment for Group B Streptococcus (GBS) infections, and its use should be limited to specific situations where first-line agents cannot be used, such as in patients with severe penicillin allergy who cannot tolerate cephalosporins or when treating complicated GBS infections requiring broader coverage. Penicillin G is the preferred antibiotic for GBS prophylaxis during labor and for treating GBS infections, with ampicillin being an acceptable alternative 1. For penicillin-allergic patients without anaphylaxis risk, cefazolin is recommended 1. The standard regimen for intrapartum GBS prophylaxis is penicillin G 5 million units IV initially, then 2.5-3 million units every 4 hours until delivery. Ceftriaxone is less preferred because it has broader antimicrobial coverage than needed for GBS alone, potentially contributing to antibiotic resistance. Additionally, ceftriaxone crosses the placenta and could affect neonatal microbiome development. GBS is almost universally susceptible to penicillins, making them more appropriate first-line choices for both efficacy and antimicrobial stewardship.
Some key points to consider when deciding on the use of ceftriaxone for GBS infections include:
- The potential for antibiotic resistance with the use of broad-spectrum antibiotics like ceftriaxone 1
- The importance of considering alternative treatments, such as penicillin or ampicillin, for patients with GBS infections 1
- The need to weigh the benefits and risks of using ceftriaxone in specific situations, such as in patients with severe penicillin allergy or complicated GBS infections 1
Overall, the use of ceftriaxone for GBS infections should be approached with caution and considered only in specific situations where first-line agents cannot be used. The preferred treatment for GBS infections remains penicillin G or ampicillin, with cefazolin being an alternative for penicillin-allergic patients without anaphylaxis risk.
From the Research
Group B Streptococcus and Antibiotic Prophylaxis
- Group B Streptococcus (GBS) is a leading cause of neonatal disease worldwide, and invasive disease in adults is becoming more prevalent 2.
- Intrapartum antibiotic prophylaxis is used to prevent the transmission of GBS from mother to neonate during delivery, with penicillin being the primary choice 2, 3.
Ceftriaxone as an Alternative Antibiotic
- There is no direct evidence in the provided studies that supports the use of ceftriaxone for Group B Streptococcus prophylaxis.
- However, cefazolin, a cephalosporin antibiotic, is often used as an alternative to penicillin in patients with penicillin allergies 3, 4, 5.
- Ceftriaxone is a third-generation cephalosporin, but its use for GBS prophylaxis is not mentioned in the provided studies.
Antibiotic Resistance and Alternative Prophylaxis
- GBS is still recognized as being universally susceptible to beta-lactam antibiotics, but there have been reports of reduced susceptibility to beta-lactams, including penicillin, in some countries 2.
- Resistance to second-line antibiotics, such as erythromycin and clindamycin, remains high amongst GBS, with several countries noting increased resistance rates in recent years 2.
- Alternative antibiotics, such as vancomycin and clindamycin, are often used in patients with penicillin allergies, but their use may be associated with increased frequency of postnatal blood draws among neonates 6.
Clinical Practice and Guidelines
- The American College of Obstetricians and Gynecologists (ACOG) provides guidelines for antibiotic prophylaxis in GBS positive patients with penicillin allergies 3, 4.
- Clinical practice varies, with some studies showing that academic hospitals are more adherent to guidelines than nonacademic hospitals 5.
- Efforts to confirm allergy and perform penicillin hypersensitivity testing may increase compliance with guidelines for antibiotic administration 4.