Treatment of Group B Streptococcus in Urine (Non-Pregnant Patients)
Treat non-pregnant adults with Group B Streptococcus bacteriuria only if they are symptomatic or have underlying urinary tract abnormalities; asymptomatic bacteriuria does not require treatment in this population. 1
Key Distinction from Pregnancy
The CDC guidelines emphasize that universal treatment of any concentration of GBS in urine applies specifically to pregnant women to prevent neonatal disease and should not be extrapolated to non-pregnant patients. 1 This is a critical pitfall—the pregnancy-related guidelines 2 that mandate treatment of all GBS bacteriuria during pregnancy do not apply to non-pregnant individuals.
When to Treat Non-Pregnant Patients
Treat if symptomatic: Patients presenting with dysuria, frequency, urgency, flank pain, fever, or other UTI symptoms require antibiotic therapy. 1, 3
Treat if underlying urinary tract abnormalities exist: This includes chronic renal failure, structural urinary tract abnormalities, recurrent UTIs, or immunocompromising conditions like diabetes mellitus. 3, 4 Studies show that 60% of non-pregnant adults with GBS UTI have urinary tract abnormalities and 27% have chronic renal failure. 3
Do not treat asymptomatic bacteriuria: In otherwise healthy non-pregnant adults without urinary tract abnormalities, GBS bacteriuria without symptoms does not warrant treatment. 1
Antibiotic Selection
First-line therapy: Penicillin G or Ampicillin
- Penicillin G 500 mg orally every 6-8 hours for 7-10 days (preferred due to narrow spectrum) 1
- Ampicillin 500 mg orally every 8 hours for 7-10 days (acceptable alternative) 1
- All GBS isolates in studies have shown universal sensitivity to penicillin and ampicillin 3, 5
For penicillin-allergic patients: Clindamycin
- Clindamycin 300-450 mg orally every 8 hours 1
- Critical caveat: Perform susceptibility testing before use due to increasing resistance patterns 1
Avoid gentamicin: Studies demonstrate GBS resistance to aminoglycosides 3
Clinical Outcomes and Follow-Up
GBS accounts for approximately 2% of positive urine cultures in non-pregnant adults, with 85% occurring in women. 3 Despite appropriate treatment, poor clinical outcomes occur in 18% of episodes, underscoring the importance of identifying underlying urinary tract pathology. 3
Follow-up urine culture after treatment completion is warranted in patients with recurrent UTIs or underlying urinary tract abnormalities to ensure eradication. 1
Screening for Underlying Pathology
The presence of GBS in urine signals a need for screening for urinary tract abnormalities, particularly in patients with recurrent infections. 3 Consider urologic evaluation in patients with: