From the Guidelines
Yes, you should endorse this finding to the dayshift team for further orders, as Group B Streptococcus (GBS) in vaginal cultures of a symptomatic patient typically requires treatment to prevent complications, especially in a patient already dealing with starvation ketoacidosis. The most recent and highest quality study, from 2020 1, emphasizes the importance of maternal screening for GBS and intrapartum antibiotics for positive screening in reducing early-onset GBS disease risk. However, this study primarily focuses on the management of at-risk infants rather than the treatment of GBS colonization in the mother.
For the treatment of GBS colonization in pregnant women, guidelines from the CDC, as outlined in studies from 2002 1 and 2010 1, recommend intrapartum antibiotic prophylaxis for women identified as GBS carriers. The standard treatment for GBS colonization is usually intrapartum antibiotics such as penicillin G, 5 million units intravenously initial dose, then 2.5 million units intravenously every 4 hours until delivery, or ampicillin, 2 g intravenously initial dose, then 1 g intravenously every 4 hours until delivery, for women without penicillin allergy. For penicillin-allergic patients, alternative regimens are recommended, including cefazolin for those not at high risk for anaphylaxis, or clindamycin and erythromycin susceptibility testing for those at high risk.
The dayshift team will need to review the patient's medical history, allergies, and current medications before prescribing appropriate treatment. Given the patient's current condition of starvation ketoacidosis, it is crucial to manage both conditions appropriately to prevent any potential complications. The team may also want to reassess the patient's ketoacidosis management in light of this infection.
Key points to consider include:
- The patient's GBS colonization status and symptoms
- The patient's medical history, including any allergies or current medications
- The appropriate antibiotic regimen based on the patient's allergy status and other factors
- The need for ongoing monitoring and management of both the GBS infection and the starvation ketoacidosis.
From the FDA Drug Label
Antibiotic therapy for Group A β-hemolytic streptococcal infections should be maintained for at least 10 days to reduce the risk of rheumatic fever.
The patient has Group B strep, not Group A. No specific dosage or treatment duration for Group B strep is mentioned in the label. The FDA drug label does not answer the question.
From the Research
Group B Strep Infection
- Group B streptococcal (GBS) infection is a significant cause of neonatal morbidity and mortality, with a colonization rate of 10-40% in pregnant women 2, 3.
- The infection can be transmitted to the newborn during passage through the birth canal, and approximately 3% of colonized children develop a serious early-onset infection, particularly meningitis 2.
Diagnosis and Treatment
- Vaginal cultures are used to diagnose GBS infection, and the results can be affected by digital vaginal examination, although the impact is minimal 3.
- Antibiotic sensitivity testing is essential to determine the appropriate treatment, with penicillin being the drug of choice and vancomycin as an alternative in cases of penicillin hypersensitivity 3, 4.
- The accuracy of self-collected GBS cultures is high, with a sensitivity of 91.7% when combining patient-collected samples, and 58% of women prefer self-sampling 5.
Management and Prevention
- Intrapartum antibiotic prophylaxis is recommended for women with GBS colonization to reduce the risk of early-onset neonatal GBS infection 2.
- The risk-benefit balance of antibiotic prophylaxis should be considered, taking into account the risk of anaphylactic reactions and the potential long-term adverse effects of antibiotic exposure during delivery 2.
- In non-pregnant women, GBS infection often presents with vulval or vaginal soreness and discharge, and may be associated with other infections such as candidal infection or dermatosis 6.