What is the treatment for beta strep (Group B streptococcal) sepsis?

Treatment of Group B Streptococcal (GBS) Sepsis

For Group B streptococcal sepsis, intravenous penicillin G is the first-line treatment, with a recommended dose of 3-4 million units IV every 4 hours for adults or 250,000-300,000 units/kg/day divided every 4-6 hours for children. 1, 2

Initial Management

Adult Treatment

1. First-line therapy:

   • Penicillin G: 5 million units IV initial dose, then 3 million units IV every 4 hours 1, 2
   • OR Ampicillin: 2 g IV initial dose, then 1 g IV every 4 hours 1

2. For penicillin-allergic patients:

   • Non-anaphylactic reactions: Cefazolin 2 g IV initial dose, then 1 g IV every 8 hours 1
   • Anaphylactic reactions:
     • If GBS isolate is susceptible: Clindamycin 900 mg IV every 8 hours 1
     • If susceptibility unknown or resistant: Vancomycin 1 g IV every 12 hours 1

Pediatric Treatment

1. Neonatal GBS sepsis:

   • Ampicillin plus gentamicin initially 3
   • Once GBS is confirmed: Penicillin G 250,000 units/kg/day divided every 4 hours (for meningitis) or 150,000-300,000 units/kg/day divided every 4-6 hours (for other serious infections) 2

2. Children beyond neonatal period:

   • Penicillin G 250,000-300,000 units/kg/day divided every 4 hours 2
   • Maximum dose: 12-20 million units/day 2

Diagnostic Approach

1. Obtain before starting antibiotics (but do not delay treatment >45 minutes):

   • Blood cultures
   • Complete blood count with differential
   • Chest radiograph (if respiratory symptoms present)
   • Lumbar puncture if stable and sepsis suspected 3

2. Neonatal assessment algorithm:

   • For neonates with signs of sepsis: Full diagnostic evaluation and immediate antibiotic therapy 1
   • For well-appearing neonates with maternal chorioamnionitis: Limited evaluation (blood culture and CBC) and antibiotic therapy 1

Duration of Therapy

• Uncomplicated bacteremia: 10-14 days
• Meningitis: 14-21 days
• Endocarditis: 4-6 weeks

Important Considerations

• Timing is critical: Administer antibiotics within 1 hour of recognizing sepsis to reduce mortality 3, 4
• Source control: Identify and address any focus of infection promptly 3
• Reassess therapy: Daily evaluation for potential de-escalation once culture results are available 3
• Combination therapy: May be considered initially for septic shock but should be narrowed once susceptibilities are known 3

Common Pitfalls to Avoid

• Delayed antibiotic administration: Each hour delay increases mortality significantly 3, 4
• Inadequate dosing: Standard dosing may be insufficient in sepsis due to altered pharmacokinetics 4
• Failure to narrow therapy: Once GBS is identified, targeted therapy with penicillin G is preferred over broad-spectrum agents 3
• Overlooking risk factors: In neonates, maternal factors such as prolonged rupture of membranes (>18 hours), prematurity, and intrapartum fever significantly increase risk 5

Group B streptococcal sepsis remains a significant cause of morbidity and mortality, particularly in neonates and adults with comorbidities such as diabetes mellitus, malignancy, and hepatic failure 6. Prompt recognition and appropriate antibiotic therapy are essential for improving outcomes.