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Author: Admin | 2025-04-28
Who are hypersensitive to penicillin. Pregnant women who are colonized with GBS in the genital or rectal areas can transmit GBS infection to their infants during labor and delivery resulting in invasive neonatal infection that can be associated with substantial morbidity and mortality. Intrapartum anti-infective prophylaxis for prevention of early-onset neonatal GBS disease is administered selectively to women at high risk for transmitting GBS infection to their neonates. When intrapartum prophylaxis is indicated in the mother, penicillin G (5 million units IV initially followed by 2.5 million units IV every 4 hours until delivery) is the regimen of choice and ampicillin (2 g IV initially followed by 1 g IV every 4 hours until delivery) is the preferred alternative. When intrapartum prophylaxis to prevent GBS in the neonate is indicated in women who are hypersensitive to penicillins, the CDC recommends a regimen of IV clindamycin (900 mg IV every 8 hours until delivery) or IV erythromycin (500 mg IV every 6 hours until delivery) for those allergic to penicillins who are at high risk for anaphylaxis (e.g., those with a history of immediate penicillin hypersensitivity, such as anaphylaxis, angioedema, or urticaria; those with a history of asthma or other conditions that would make anaphylaxis more dangerous or difficult to treat, including individuals receiving β-adrenergic blocking agents). For those allergic to penicillins who are not at high risk for anaphylaxis, the CDC states that a regimen of IV cefazolin (2 g IV initially followed by 1 g IV every 8 hours until delivery) should be used since this cephalosporin has a narrow spectrum of activity and is associated with high intraamniotic concentrations.The fact that S. agalactiae (group B streptococci) with in vitro resistance to clindamycin and erythromycin have been reported with increasing frequency should be considered when choosing an alternative to penicillins. When use of erythromycin or clindamycin is being considered in a women hypersensitive to penicillin, in vitro susceptibility testing of clinical isolates obtained during GBS prenatal screening should be performed whenever possible to determine if the isolates are susceptible to these drugs. Strains of GBS resistant to erythromycin often
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