From the Guidelines
Cipro (ciprofloxacin) is not recommended for treating Group B streptococcus (GBS) infections. The most recent and highest quality study, published in 2020 1, recommends penicillin G and ampicillin as the first-line treatments for GBS infections. For penicillin-allergic patients, clindamycin (900 mg IV every 8 hours) or vancomycin are the preferred alternatives. Ciprofloxacin is ineffective against GBS because fluoroquinolones generally have poor activity against streptococci.
Key Points to Consider
- GBS remains highly susceptible to beta-lactam antibiotics like penicillins and cephalosporins due to their mechanism of action that disrupts bacterial cell wall synthesis 1.
- Using ciprofloxacin for GBS infections could lead to treatment failure and potentially worse outcomes, so it's essential to select antibiotics with proven efficacy against this particular pathogen.
- The Centers for Disease Control and Prevention (CDC) guidelines, as outlined in the 2010 study 1, also recommend penicillin G, ampicillin, or cefazolin for intrapartum antibiotic prophylaxis, but do not mention ciprofloxacin as a treatment option.
- The American Academy of Pediatrics (AAP) updates guidelines for the management of at-risk infants, as seen in the 2020 study 1, which further supports the use of penicillin G, ampicillin, clindamycin, or vancomycin for GBS infections, but not ciprofloxacin.
Treatment Options
- Penicillin G or ampicillin are the first-line treatments for GBS infections, with typical dosing of penicillin G at 3-4 million units IV every 4 hours for severe infections.
- For penicillin-allergic patients, clindamycin (900 mg IV every 8 hours) or vancomycin are the preferred alternatives.
- Cefazolin is recommended for women allergic to penicillin who are at low risk of anaphylaxis 1.
From the Research
Effectiveness of Cipro for Treating Group B Strep
- Ciprofloxacin is not typically recommended for treating Group B streptococcus (GBS) infections, as the primary treatment usually involves penicillin or other antibiotics 2, 3.
- Studies have shown that while ciprofloxacin may be effective against some GBS isolates, resistance rates can be significant, ranging from 0% to 32% 4, 5.
- In one study, 14 out of 52 GBS clinical isolates exhibited intermediate or decreased sensitivity to ciprofloxacin, highlighting the potential for resistance 4.
- Another study found that 0% to 0.7% of GBS isolates were resistant to ciprofloxacin, but this does not necessarily mean it is an effective treatment option 5.
Alternative Treatment Options
- Penicillin is generally considered the first-line treatment for GBS infections, with alternatives such as clindamycin, erythromycin, or vancomycin used in cases of penicillin allergy 2, 3.
- The choice of antibiotic should be guided by the organism's antibiotic sensitivity pattern, and in cases where resistance is a concern, alternative antibiotics such as cephalosporins or vancomycin may be used 3, 4.
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