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

From the Guidelines

Group B strep UTI should be treated with antibiotics, with penicillins being the first-line treatment, as recommended by the CDC guidelines 1. The treatment regimen for group B strep UTI typically involves amoxicillin 500 mg three times daily or amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days.

• For patients with penicillin allergies, alternatives include:
  • cephalexin 500 mg four times daily
  • trimethoprim-sulfamethoxazole 160/800 mg twice daily
  • nitrofurantoin 100 mg twice daily for 7 days, though nitrofurantoin should be avoided in upper UTIs
• Severe infections may require intravenous antibiotics like ampicillin 2 g every 6 hours or ceftriaxone 1-2 g daily, as indicated by the CDC guidelines 1. It's essential to complete the full course of antibiotics even if symptoms improve quickly, and increased fluid intake helps flush bacteria from the urinary tract. In pregnant women, GBS UTI is particularly concerning as it can cause complications, so screening and treatment are essential during pregnancy, with women receiving intrapartum chemoprophylaxis as recommended by the CDC guidelines 1. The bacterium is naturally resistant to some antibiotics like clindamycin and erythromycin, which is why penicillins remain the preferred treatment due to their effectiveness against the cell wall structure of this gram-positive organism. Women with GBS urinary tract infections during pregnancy should receive appropriate treatment at the time of diagnosis as well as intrapartum GBS prophylaxis, as stated in the CDC guidelines 1.

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 group B strep UTI is ampicillin (PO) with a dose of 500 mg q.i.d. for at least 10 days to ensure elimination of the organism and prevent sequelae of streptococcal disease 2.

From the Research

Treatment for Group B Strep UTI

• The treatment for group B strep UTI is not explicitly mentioned in the provided studies, but we can infer some information from the studies on group B strep infections in general.
• According to 3, high doses of benzylpenicillin (penicillin G) are recommended for the treatment of serious group B streptococcal infections.
• However, 4 suggests that patients with group B strep bacteriuria should be treated with nitrofurantoin.
• It's also important to note that antibiotic resistance is a concern, and 5 reports that while group B strep is still susceptible to beta-lactam antibiotics, there have been reports of reduced susceptibility to these antibiotics.
• In cases where patients are allergic to penicillin, alternative antibiotics such as vancomycin, cefazolin, or clindamycin may be used, as mentioned in 6.
• The choice of antibiotic should be guided by the organism's antibiotic sensitivity pattern, and antibiotic susceptibility testing should be performed to ensure the most effective treatment, as recommended in 4 and 6.

Antibiotic Resistance and Treatment

• The studies highlight the importance of considering antibiotic resistance when treating group B strep infections.
• 4 found that some group B strep isolates exhibited intermediate or decreased sensitivity to certain antibiotics, including ampicillin and penicillin.
• 5 reports that resistance to second-line antibiotics, such as erythromycin and clindamycin, remains high amongst group B strep.
• Therefore, it's crucial to select an antibiotic that is effective against the specific group B strep isolate, and to monitor for signs of antibiotic resistance.

Specific Treatment Recommendations

• For group B strep UTI, nitrofurantoin may be a suitable treatment option, as suggested by 4.
• However, the treatment should be guided by the results of antibiotic susceptibility testing, and the choice of antibiotic should be based on the specific characteristics of the group B strep isolate.
• In general, high doses of benzylpenicillin (penicillin G) or alternative antibiotics such as vancomycin, cefazolin, or clindamycin may be used, depending on the patient's allergy status and the antibiotic sensitivity pattern of the isolate, as mentioned in 3 and 6.