What are the treatment recommendations for a non-pregnant patient with symptoms of sore throat and a throat culture positive for Group B Streptococcus (GBS)?

From the Guidelines

For a non-pregnant patient with a sore throat and a positive throat culture for Group B Streptococcus (GBS), treatment with antibiotics is not routinely recommended, as GBS rarely causes pharyngitis and finding it in a throat culture may represent colonization rather than true infection 1. The patient's symptoms and overall clinical presentation should be considered when deciding on treatment. If the patient has significant symptoms and no other identified cause, a 10-day course of penicillin V (500 mg orally twice daily) may be considered, as it is the recommended antimicrobial agent for patients with acute sore throat who require antibiotic treatment 1. For patients with penicillin allergy, alternatives are not specified in the provided guideline, but other sources suggest clindamycin or azithromycin as potential options. Symptomatic relief can be provided with over-the-counter pain relievers like acetaminophen or ibuprofen, as they are recommended for relief of acute sore throat symptoms 1. Some key points to consider when treating a patient with GBS throat culture include:

• The use of corticosteroids in conjunction with antibiotic therapy is not routinely recommended, but can be considered in adult patients with more severe presentations 1
• Zinc gluconate is not recommended for use in sore throat 1
• Complementary treatments, such as herbal treatments or acupuncture, have inconsistent evidence and are not recommended 1
• Antibiotics should not be used to relieve symptoms in patients with less severe presentation of sore throat, and the benefits of antibiotics must be weighed against side effects and increased antibacterial resistance 1

From the Research

Treatment Recommendations for Non-Pregnant Patients with Sore Throat and GBS

• For a non-pregnant patient with symptoms of sore throat and a throat culture positive for Group B Streptococcus (GBS), the treatment approach should be guided by the presence of symptoms and the risk of bacterial pharyngitis 2.
• The patient should be encouraged in self-management, and ibuprofen and naproxen are recommended for symptomatic treatment 2.
• If antibiotics are considered, clinical scores (Centor, McIsaac, FeverPAIN) should be used to assess the risk of bacterial pharyngitis 2.
• Penicillin is the first choice for antibiotic treatment, with clarithromycin as an alternative 2.
• The antibiotic should be taken for 5-7 days 2.

Antibiotic Susceptibility of GBS

• GBS is universally susceptible to beta-lactam antibiotics, including penicillin 3, 4, 5, 6.
• However, there have been reports of reduced susceptibility to beta-lactams, including penicillin, in some countries 6.
• Resistance to second-line antibiotics, such as erythromycin and clindamycin, remains high amongst GBS, with several countries noting increased resistance rates in recent years 3, 4, 5, 6.
• Vancomycin is an effective alternative for patients allergic to penicillin, but there have been two documented cases of vancomycin resistance in GBS 6.

Specific Considerations for GBS Treatment

• The selection of an alternative antibiotic for patients allergic to penicillin should be guided by contemporary resistance patterns observed in that region 5.
• The treatment approach should take into account the specific type of GBS strain, as some strains may be more resistant to certain antibiotics than others 5.