From the Guidelines
Ceftriaxone is a suitable alternative for the treatment of Group B Streptococcus (GBS) urinary tract infections (UTIs) when penicillins cannot be used due to allergies or resistance patterns, with a recommended dose of 1-2 grams intravenously or intramuscularly once daily for 7-14 days, depending on infection severity 1.
Treatment Considerations
When considering the use of ceftriaxone for GBS UTIs, it's essential to note that penicillin or ampicillin is usually the preferred treatment due to GBS's high susceptibility to these antibiotics. However, ceftriaxone can be used as an alternative when necessary.
- The dose and duration of ceftriaxone treatment may vary depending on the severity of the infection and the patient's response to treatment.
- It's crucial to obtain urine cultures before starting antibiotics to confirm the diagnosis and check susceptibility.
- Patients should complete the full course of antibiotics even if symptoms improve quickly, and should increase fluid intake to help flush bacteria from the urinary tract.
Important Considerations
- If symptoms worsen or don't improve within 48-72 hours, medical reassessment is necessary.
- The use of ceftriaxone should be guided by local resistance patterns and susceptibility testing whenever possible.
- Ceftriaxone works by inhibiting bacterial cell wall synthesis, which is effective against GBS.
Additional Recommendations
- For complicated UTIs, the higher dose and longer duration of ceftriaxone may be necessary.
- In cases where penicillins cannot be used, ceftriaxone is a suitable alternative for the treatment of GBS UTIs.
- The Infectious Diseases Society of America & European Society for Microbiology and Infectious Diseases recommends ceftriaxone as a first-choice option for empiric treatment of acute pyelonephritis in adults 1.
From the Research
Ceftriaxone for Group B Strep UTI
- Ceftriaxone is a third-generation cephalosporin antibiotic that has been used to treat various bacterial infections, including urinary tract infections (UTIs) 2.
- However, there is evidence to suggest that Group B Streptococcus (GBS) isolates with reduced penicillin susceptibility may also be non-susceptible to ceftriaxone 2.
- A study found that 36% of GBS isolates with reduced penicillin susceptibility were non-susceptible to ceftriaxone, highlighting the potential limitations of using this antibiotic to treat GBS UTIs 2.
Antibiotic Resistance in Group B Streptococcus
- GBS is generally susceptible to beta-lactam antibiotics, but there have been reports of reduced susceptibility to these antibiotics, including penicillin and ceftriaxone 3.
- Resistance to second-line antibiotics, such as erythromycin and clindamycin, is also a concern, with several countries reporting increased resistance rates in recent years 3.
- A study found that 33.6% of GBS UTI isolates were multidrug-resistant, with high rates of resistance to azithromycin, clindamycin, erythromycin, and tetracycline 4.
Ceftriaxone Treatment of UTIs
- Ceftriaxone has been used to treat complicated UTIs, but its use has been associated with an increased risk of enterococcal re-infection and prolonged hospitalization 5.
- A study found that patients treated with ceftriaxone had significantly longer hospital stays and higher rates of complications and re-infections compared to those treated with co-amoxiclav and gentamicin 5.
- However, ceftriaxone may still be a viable treatment option for uncomplicated UTIs, particularly in cases where other antibiotics are not effective or are contraindicated 6.