What is the treatment for Urinary Tract Infection (UTI) with Group B Streptococcus (GBS)?

From the FDA Drug Label

For genitourinary or gastrointestinal tract infections other than gonorrhea in men and women, the usual dose is 500 mg q.i.d. in equally spaced doses; severe or chronic infections may require larger doses. In infections caused by haemolytic strains of streptococci, a minimum of 10 days' treatment is recommended to guard against the risk of rheumatic fever or glomerulonephritis

The treatment for a UTI with Group B streptococcus may involve ampicillin 500 mg four times a day, and the therapy should be continued for a minimum of 10 days to guard against the risk of complications. 1

From the Research

For a urinary tract infection (UTI) caused by Group B Streptococcus (GBS), the recommended treatment is typically penicillin or ampicillin, as GBS remains highly susceptible to beta-lactam antibiotics 2. First-line therapy would be penicillin G 2-4 million units IV every 4 hours for severe infections, or amoxicillin 500 mg orally three times daily for 7-10 days for uncomplicated cases. For patients with penicillin allergies, alternatives include ceftriaxone 1-2 g IV daily, or clindamycin 600 mg IV every 8 hours or 300-450 mg orally four times daily, although resistance to clindamycin is common 3. Some key points to consider in the treatment of GBS UTIs include:

• The importance of adequate hydration and follow-up urine cultures after treatment completion to ensure resolution, especially for pregnant women where GBS can pose additional risks.
• The natural resistance of GBS to trimethoprim-sulfamethoxazole, making this common UTI antibiotic ineffective for GBS UTIs.
• The diversity of GBS serotypes that can cause UTIs, with serotypes V, Ia, and III being the most common causes of UTIs 3.
• The need for appropriate antibiotic use and stewardship, particularly in patients with penicillin allergies, to prevent undertreatment or overtreatment 4. Treatment duration is generally 7-10 days for uncomplicated UTIs and 10-14 days for complicated infections. It is essential to note that while vancomycin is an option for patients with severe penicillin allergies, its use should be reserved for cases where other options are not suitable due to the risk of resistance development 2.