From the Guidelines
The recommended treatment for a Group B Streptococcus (GBS) urinary tract infection is typically a course of antibiotics, with the specific choice and duration guided by current standards of care for urinary tract infection during pregnancy, as outlined in the CDC guidelines 1. When considering treatment options, it's crucial to prioritize the most effective and safest choices for the patient, taking into account factors such as pregnancy status and potential allergies to penicillin.
- First-line treatment usually involves penicillin-based antibiotics, but the specific regimen may vary based on the patient's condition and the severity of the infection.
- For patients with penicillin allergies, alternatives such as cephalexin, clindamycin, or trimethoprim-sulfamethoxazole may be considered, as noted in general principles of managing urinary tract infections.
- The treatment duration may be extended for complicated infections or in pregnant women, emphasizing the need for careful management to prevent potential complications.
- Follow-up urine cultures are recommended after treatment completion to ensure the infection has cleared, especially in pregnant women where GBS can pose risks to the newborn, as highlighted in the guidelines for preventing perinatal group B streptococcal disease 1. Key considerations in managing GBS UTIs include:
- The natural sensitivity of GBS to penicillins, which inhibit cell wall synthesis in the bacteria.
- The importance of completing the full course of antibiotics, even if symptoms improve before completion.
- Increased fluid intake to help flush bacteria from the urinary system. Given the potential risks associated with GBS infections, particularly in pregnant women, it is essential to adhere to evidence-based guidelines and consult the most recent recommendations for the management of Group B Streptococcus urinary tract infections 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Group B Strep UTI
The recommended treatment for a group B strep (Streptococcus agalactiae) urinary tract infection (UTI) typically involves the use of antibiotics.
- The choice of antibiotic may depend on various factors, including the severity of the infection, the patient's medical history, and the results of antibiotic susceptibility testing 2, 3, 4.
- According to the studies, group B strep isolates are generally susceptible to beta-lactam antibiotics, such as ampicillin, penicillin, and ceftriaxone 2, 3, 4.
- However, there have been reports of reduced susceptibility to beta-lactams, including penicillin, in some countries 5.
- Resistance to second-line antibiotics, such as erythromycin and clindamycin, remains high amongst group B strep isolates, with several countries noting increased resistance rates in recent years 5.
- In cases where patients are allergic to penicillin and second-line antibiotics are ineffective, vancomycin may be administered 5, 4.
- Nitrofurantoin may be considered for the treatment of group B strep bacteriuria 4.
Antibiotic Resistance Patterns
The antibiotic resistance patterns of group B strep clinical isolates have been evaluated in several studies.
- One study found that all isolates were sensitive to vancomycin, ofloxacin, ampicillin, ciprofloxacin, nitrofurantoin, and penicillin 4.
- However, the study also found that 31% of the isolates were resistant to azithromycin and ceftriaxone, 19% to clindamycin, 15% to cefazolin, and 13% to cefamandole 4.
- Another study found that 32% of the isolates were resistant to azithromycin, 21% to clindamycin, 25% to erythromycin, and 23% to tetracycline 2.
- The studies suggest that antibiotic susceptibility testing should be performed to guide the selection of antibiotics for the treatment of group B strep infections 2, 3, 4.