What is the treatment for Group B Streptococcus (GBS) urinary tract infection (UTI)?

From the Guidelines

Group B Streptococcus (GBS) urinary tract infections should be treated according to current standards of care for urinary tract infection during pregnancy, with the choice of antibiotic depending on the patient's allergy status and susceptibility testing results, as recommended by the CDC guidelines 1.

Treatment Approach

The treatment approach for GBS UTI involves administering antibiotics that target this gram-positive bacterium.

• The first-line treatment is penicillin, specifically penicillin G or ampicillin, administered for 7-10 days.
• For patients with penicillin allergies, alternatives include cephalosporins like cefazolin or ceftriaxone if the allergy is not severe, or clindamycin, erythromycin, or vancomycin for those with severe penicillin allergies.

Antibiotic Regimens

Typical oral regimens include:

• Amoxicillin 500 mg three times daily
• Penicillin V 500 mg four times daily For more severe infections requiring intravenous therapy:
• Ampicillin 1-2 g every 4-6 hours
• Penicillin G 2-4 million units every 4-6 hours

Importance of Completion and Follow-up

It's essential to complete the full course of antibiotics even if symptoms improve before completion.

• Adequate hydration helps flush bacteria from the urinary tract and may reduce symptoms.
• GBS is naturally resistant to some antibiotics like trimethoprim-sulfamethoxazole, so susceptibility testing is valuable to ensure effective treatment.
• Follow-up urine cultures after treatment completion are recommended to confirm the infection has been cleared, especially for pregnant women or those with recurrent infections, as emphasized in the guidelines 1.

From the FDA Drug Label

Infections of the gastrointestinal and genitourinary tracts (including those caused by Neisseria gonorrhoeae in females) Patients weighing 40 kg (88 lbs) or more: 500 mg every 6 hours. Patients weighing less than 40 kg (88 lbs): 50 mg/kg/day in equally divided doses at 6- to 8- hour intervals.

The treatment for Group B Streptococcus (GBS) urinary tract infection (UTI) is Ampicillin 500 mg every 6 hours for patients weighing 40 kg or more, and 50 mg/kg/day in equally divided doses at 6- to 8-hour intervals for patients weighing less than 40 kg 2.

• The duration of treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic or evidence of bacterial eradication has been obtained.
• A minimum of 10-days treatment is recommended for any infection caused by Group A beta-hemolytic streptococci to help prevent the occurrence of acute rheumatic fever or acute glomerulonephritis.

From the Research

Treatment for Group B Streptococcus (GBS) Urinary Tract Infection (UTI)

• The treatment for GBS UTI is not explicitly mentioned in the provided studies, but we can look at the general treatment options for UTIs and GBS infections.
• For serious GBS infections, high doses of benzylpenicillin (penicillin G) are recommended 3.
• According to a study on antibiotic resistance patterns in invasive GBS isolates, all isolates were sensitive to penicillin, ampicillin, cefazolin, cefotaxime, and vancomycin 4.
• Another study found that all GBS isolates were sensitive to penicillin G, with no sign of reduced penicillin susceptibility 5.
• However, resistance to alternative agents such as erythromycin and clindamycin is an increasing concern 4, 5.
• For UTIs caused by antibiotic-resistant Gram-negative bacteria, treatment options include nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, and β-lactams such as amoxicillin-clavulanate 6.
• It is essential to note that the treatment for GBS UTI may vary depending on the specific circumstances and the patient's medical history, and should be guided by a healthcare professional.

Antibiotic Resistance and Treatment Options

• GBS remains susceptible to beta-lactams, but resistance to alternative agents such as erythromycin and clindamycin is an increasing concern 4, 5.
• Clindamycin and erythromycin resistance was found to be associated with serotype V 4.
• Inducible clindamycin resistance was associated with the erm genotype 4.
• The use of new antimicrobials should be done wisely to avoid resistance development 6.