What is the recommended treatment for Group B Streptococcus (GBS) Urinary Tract Infection (UTI) in a non-pregnant individual?

Treatment of Group B Streptococcus UTI in Non-Pregnant Individuals

For non-pregnant individuals with Group B Streptococcus (GBS) urinary tract infections, penicillin G or ampicillin are the first-line treatments due to their narrow spectrum of activity and proven effectiveness against GBS. 1

First-Line Treatment Options

• Penicillin G: 5 million units IV initial dose, then 2.5-3.0 million units IV every 4 hours until clinical improvement 2
• Ampicillin: 2 g IV initial dose, then 1 g IV every 4 hours until clinical improvement 2
• Oral Amoxicillin: For less severe infections, 500 mg every 8 hours or 875 mg every 12 hours 3

For Penicillin-Allergic Patients

Low Risk of Anaphylaxis:

• Cefazolin: 2 g IV initial dose, then 1 g IV every 8 hours 2, 1

High Risk of Anaphylaxis:

• Clindamycin: 900 mg IV every 8 hours (only if susceptibility testing confirms sensitivity) 2, 1
• Vancomycin: 1 g IV every 12 hours (for clindamycin-resistant strains) 2, 1

Treatment Duration

• Uncomplicated UTIs: 7-10 days 1
• Complicated UTIs or pyelonephritis: 10-14 days 1
• Treatment should continue for at least 48-72 hours after the patient becomes asymptomatic 3

Important Considerations

1. Susceptibility Testing: Essential for penicillin-allergic patients due to increasing resistance to alternative antibiotics, particularly macrolides and clindamycin 2, 1

2. Antibiotic Resistance Patterns: Recent studies show that while GBS remains universally susceptible to penicillin, ampicillin, and vancomycin, there is high resistance to clindamycin (77.34%) and tetracycline (88.46%) 4

3. Underlying Conditions: GBS UTIs in non-pregnant adults often signal underlying urinary tract abnormalities (60%) or chronic renal failure (27%), warranting further investigation 5

4. Avoid Macrolides When Possible: Erythromycin is no longer recommended for GBS infections due to increasing resistance 2, 1

5. Fluoroquinolones: Should be restricted as empiric therapy due to increasing resistance rates and FDA warnings about serious side effects 1, 6

Clinical Follow-up

• Obtain follow-up urine culture after completion of treatment to confirm eradication 1
• Consider screening for urinary tract abnormalities, especially in patients with recurrent GBS UTIs 5

Pitfalls to Avoid

1. Don't confuse with pregnancy protocols: Treatment for GBS UTI in non-pregnant individuals focuses on resolving the infection, while in pregnancy additional considerations for preventing neonatal transmission apply 2

2. Don't use erythromycin: GBS is increasingly resistant to macrolide antibiotics 2, 1

3. Don't neglect susceptibility testing: For penicillin-allergic patients, susceptibility testing is crucial before using alternative antibiotics 1

4. Don't overlook underlying conditions: GBS UTI may signal underlying urinary tract abnormalities that require further evaluation 5