What is the treatment for Streptococcus agalactiae (Group B Streptococcus, GBS) infection?

From the Guidelines

The treatment for Streptococcus agalactiae (Group B Streptococcus, GBS) infection typically involves antibiotics, with penicillin G being the first-line treatment, as recommended by the most recent guidelines 1. For invasive GBS infections in adults, intravenous penicillin G at 4 million units every 4 hours for 10-14 days is recommended. For those with penicillin allergy, alternatives include ceftriaxone (2g IV daily) or vancomycin (15-20 mg/kg IV every 8-12 hours). Some key points to consider in the treatment of GBS infection include:

• For pregnant women with GBS colonization, intrapartum antibiotic prophylaxis is given during labor to prevent transmission to the newborn, typically with penicillin G 5 million units IV initially, then 2.5-3 million units every 4 hours until delivery, as outlined in the guidelines from the CDC 1.
• Ampicillin (2g IV initially, then 1g every 4 hours) is an acceptable alternative.
• For penicillin-allergic patients without anaphylaxis history, cefazolin (2g IV initially, then 1g every 8 hours) can be used, as recommended by the American Academy of Pediatrics 1.
• For those with severe penicillin allergy, clindamycin or vancomycin may be used based on susceptibility testing, with clindamycin being the preferred option for women colonized with GBS that is known to be susceptible to clindamycin 1. Treatment duration varies by infection type, with longer courses needed for endocarditis, meningitis, or osteomyelitis. GBS remains highly susceptible to penicillins because it has not developed the resistance mechanisms seen in other streptococci, making beta-lactam antibiotics particularly effective against this pathogen. It is essential to note that the management of infants born to mothers with GBS colonization has been updated, with recommendations for infants born earlier than 35 weeks’ gestation, including performing a blood culture and starting antibiotic treatment even after sufficient intrapartum antibiotic prophylaxis 1.

From the FDA Drug Label

Serious infections, such as pneumonia and endocarditis, due to susceptible strains of streptococci (including S (maximum dose of 12 to 20 million units/day) (penicillin-susceptible strains) Arthritis 100,000 units/kg/day in 4 equally divided doses for 7 to 10 days Meningitis 250,000 units/kg/day in equal doses every 4 hours for 10 to 14 days Endocarditis 250,000 units/kg/day in equal doses every 4 hours for 4 weeks

The treatment for Streptococcus agalactiae (Group B Streptococcus, GBS) infection is penicillin (IV) at a dose of 12 to 20 million units/day, depending on the type and severity of the infection, with the duration of therapy depending on the type of infection 2.

• Arthritis: 100,000 units/kg/day in 4 equally divided doses for 7 to 10 days
• Meningitis: 250,000 units/kg/day in equal doses every 4 hours for 10 to 14 days
• Endocarditis: 250,000 units/kg/day in equal doses every 4 hours for 4 weeks Key points:
• The dosage and duration of treatment may vary depending on the specific infection and patient factors.
• Penicillin is the preferred treatment for GBS infections, but other antibiotics like clindamycin may be used in patients with penicillin allergy 3 3.

From the Research

Treatment for Streptococcus agalactiae (Group B Streptococcus, GBS) Infection

The treatment for Streptococcus agalactiae (Group B Streptococcus, GBS) infection typically involves the use of antibiotics.

• Penicillin, ampicillin, or cefazolin are recommended for prophylaxis, with clindamycin and vancomycin reserved for cases of significant maternal penicillin allergy 4.
• For non-pregnant adults, the treatment of invasive GBS disease, including skin and soft-tissue infections, typically involves the use of antibiotics, although the specific treatment approach may vary depending on the severity of the infection and the patient's underlying health conditions 5.

Antibiotic Resistance

There is growing concern about antibiotic resistance in GBS, with reports of reduced susceptibility to beta-lactams, including penicillin, and high resistance rates to second-line antibiotics such as erythromycin and clindamycin 6.

• The use of antibiotics can also alter the production and composition of membrane vesicles (MVs) in GBS, which can promote bacterial survival and antibiotic tolerance 7.
• Intrapartum antibiotic prophylaxis (IAP) is the current gold standard for preventing neonatal sepsis in GBS-positive mothers, but the management of IAP is heterogeneous and antimicrobial stewardship is lacking in most obstetric wards 8.

Intrapartum Antibiotic Prophylaxis

IAP is recommended for GBS-positive pregnant women during labor to prevent the transmission of GBS to the neonate.

• The choice of antibiotics for IAP varies, with penicillin G, amoxicillin, and co-amoxicillin being commonly used as first-line treatments 8.
• In cases of penicillin allergy, clindamycin and vancomycin may be used as alternative treatments, although the use of these antibiotics should be guided by susceptibility testing and clinical judgment 4, 6.