What is the recommended dose of Augmentin (amoxicillin/clavulanate) for treating Group B strep urinary tract infection in the first trimester of pregnancy?

Recommended Dosage of Augmentin for Group B Strep UTI in First Trimester Pregnancy

For Group B Streptococcus (GBS) urinary tract infection in the first trimester of pregnancy, the recommended dose of Augmentin (amoxicillin/clavulanate) is 375 mg three times daily for 7-10 days. 1

Treatment Rationale and Guidelines

GBS bacteriuria during pregnancy requires specific attention because:

• GBS in urine at any concentration during pregnancy should be treated as a urinary tract infection, as recommended by the CDC 1
• GBS bacteriuria at any point during pregnancy is clinically significant and requires treatment regardless of colony count 1
• Women with GBS isolated from the urine at any time during the current pregnancy should receive both:
  1. Standard treatment for UTI during pregnancy
  2. Intrapartum antibiotic prophylaxis during labor 2

Antibiotic Selection

The World Health Organization specifically recommends amoxicillin-clavulanate (Augmentin) as a first-choice option for GBS urinary tract infections 1. This recommendation is supported by:

• Augmentin's effectiveness against GBS through the clavulanic acid component, which reduces resistance in Gram-negative urinary pathogens 3
• The combination's ability to overcome resistance patterns that might be present in some GBS strains 4

Treatment Protocol

1. Initial treatment: Augmentin 375 mg three times daily for 7-10 days 1, 3
2. Follow-up culture: Perform a test-of-cure urine culture 1-2 weeks after completing treatment
3. Documentation: Document GBS bacteriuria in the prenatal record to ensure intrapartum antibiotic prophylaxis is administered during labor 1

Important Considerations

Antibiotic Resistance

• Monitor for treatment response as some GBS isolates may show decreased sensitivity to beta-lactam antibiotics 4
• If treatment fails, obtain susceptibility testing to guide alternative antibiotic selection

Intrapartum Prophylaxis

Women with GBS bacteriuria during pregnancy will require intrapartum antibiotic prophylaxis during labor with one of the following regimens 1:

• Penicillin G: 5 million units IV initial dose, then 2.5-3.0 million units IV every 4 hours until delivery
• Ampicillin: 2 g IV initial dose, then 1 g IV every 4 hours until delivery
• Cefazolin (if penicillin-allergic): 2 g IV initial dose, then 1 g IV every 8 hours until delivery

Common Pitfalls to Avoid

1. Do not re-screen for GBS later in pregnancy if bacteriuria has been documented - these women are presumed to be colonized 5
2. Do not attempt to eradicate GBS colonization before labor with oral antibiotics - this approach is ineffective 1
3. Do not withhold treatment for low colony counts - any concentration of GBS in urine during pregnancy is considered significant 1
4. Do not forget to document GBS bacteriuria to ensure appropriate intrapartum prophylaxis is administered during labor 2

Alternative Options

If Augmentin is contraindicated or not tolerated:

• Nitrofurantoin is an alternative (except at term) 1, 4
• First-generation cephalosporins may be used in non-allergic patients 5
• For penicillin-allergic patients, obtain susceptibility testing as clindamycin resistance rates can be high (up to 26.6%) 1