Does Augmentin (amoxicillin-clavulanate) cover Group B Streptococcus (GBS)?

From the Guidelines

Augmentin (amoxicillin-clavulanate) is not the recommended first-line treatment for Group B Streptococcus (GBS) infections, as the provided guidelines do not mention it as an option for intrapartum antibiotic prophylaxis. The guidelines from the CDC in 2010 1 and the policy statement from Pediatrics in 2011 1 recommend penicillin, ampicillin, or cefazolin for intrapartum antibiotic prophylaxis to prevent early-onset GBS disease.

Key Points to Consider

• The guidelines emphasize the importance of using penicillin or ampicillin for women who are not allergic to penicillin, as these antibiotics have been shown to be effective in preventing early-onset GBS disease 1.
• For women who are allergic to penicillin, cefazolin is the preferred alternative, but only for those at low risk of anaphylaxis 1.
• Augmentin, which combines amoxicillin with clavulanic acid, may be effective against GBS infections due to its penicillin-class antibiotic component, but it is not mentioned in the guidelines as a recommended option for intrapartum antibiotic prophylaxis.

Clinical Implications

• In clinical practice, the choice of antibiotic for GBS infections should be guided by the patient's allergy history and the severity of the infection.
• For severe invasive GBS infections, intravenous antibiotics would be preferred initially, and the patient should complete the full prescribed course to ensure complete eradication of the infection.
• It is essential to note that the guidelines prioritize penicillin, ampicillin, or cefazolin for intrapartum antibiotic prophylaxis, and Augmentin is not a recommended first-line treatment for GBS infections in this context.

From the Research

Antibiotic Resistance Patterns of Group B Streptococcus

• All studies 2, 3, 4, 5, 6 show that Group B Streptococcus (GBS) remains susceptible to penicillin and other beta-lactam antibiotics.
• Resistance to clindamycin and erythromycin is increasing, with rates varying across studies:
  • 26.6% and 32.9% respectively in 2
  • 5% and no data respectively in 3
  • 28% and 30% respectively in 4
  • 1.7% and 0.7% respectively in 5
  • 12.7% and 25.6% respectively in 6
• Augmentin (amoxicillin-clavulanate) is a beta-lactam antibiotic, and as such, it is expected to be effective against GBS, given the susceptibility of GBS to beta-lactam antibiotics reported in the studies 2, 3, 4, 5, 6.

Implications for Antibiotic Prophylaxis

• The increasing resistance to clindamycin and erythromycin highlights the need for susceptibility testing before using these antibiotics for GBS prophylaxis 4, 6.
• Penicillin and other beta-lactam antibiotics, such as ampicillin and cefazolin, remain effective options for GBS prophylaxis 2, 3, 5, 6.
• In cases of penicillin allergy, alternative antibiotics such as cephalosporins or vancomycin may be considered 4.