From the Research
Group B Streptococcus (GBS) urinary tract infections should be treated with penicillin, specifically penicillin G 2-4 million units IV every 4 hours, or ampicillin 1-2 grams IV every 4-6 hours for severe infections, as recommended by the most recent and highest quality study 1.
Treatment Options
- For less severe cases, oral amoxicillin 500 mg three times daily for 7-10 days is often prescribed.
- For patients with penicillin allergies, alternatives include cephalexin 500 mg four times daily, ceftriaxone 1-2 grams IV daily, or clindamycin 600 mg IV every 8 hours or 300-450 mg orally four times daily.
- Vancomycin 15-20 mg/kg IV every 8-12 hours may be used for resistant strains.
Important Considerations
- Treatment duration typically ranges from 7-14 days depending on infection severity.
- GBS is naturally resistant to aminoglycosides when used alone, so these should be avoided as monotherapy.
- Complete treatment is essential as GBS can cause serious complications, especially in pregnant women, newborns, elderly patients, and those with chronic conditions.
- Adequate hydration and follow-up urine cultures after treatment completion are recommended to ensure the infection has cleared.
Rationale
The most recent study 1 suggests that penicillin is an important core antibiotic for treating early onset GBS disease, and preventive measures, risk-based intrapartum antibiotic prophylaxis, and maternal vaccination can significantly reduce the burden of GBS disease.
Key Points
- Penicillin G or ampicillin are the first-line treatments for GBS urinary tract infections.
- Alternative antibiotics, such as cephalexin, ceftriaxone, or clindamycin, may be used in patients with penicillin allergies.
- Vancomycin may be used for resistant strains.
- Treatment duration and follow-up care are crucial to ensure the infection has cleared.