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Streptococcus Group B Infections Medication

  • Author: Christian J Woods, MD, FCCP; Chief Editor: Michael Stuart Bronze, MD  more...
 
Updated: Oct 20, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Therapy should begin immediately after blood cultures are obtained.

Penicillin G (Pfizerpen)

 

Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms. Penicillin remains the drug of choice for group B streptococcal infection.

Cefazolin (Ancef, Kefzol, Zolicef)

 

First-generation semisynthetic cephalosporin that arrests bacterial cell wall synthesis, inhibiting bacterial growth. Primarily active against skin flora, including Staphylococcus aureus. Typically used alone for skin and skin structure coverage. IV and IM dosing regimens are similar.

Cefazolin is alternative therapy to penicillin for group B streptococcal infection. Cefazolin would not be effective for meningitis.

Vancomycin (Vancocin)

 

Potent antibiotic directed against gram-positive organisms. Useful in the treatment of septicemia and skin structure infections. Indicated for patients who cannot receive or who have failed to respond to penicillins and cephalosporins or who have infections with resistant staphylococci.

To avoid toxicity, the current recommendation is to assay vancomycin trough levels after the third dose drawn 0.5 h prior to next dosing. Use creatinine clearance to adjust dose in patients diagnosed with renal impairment.

May need to adjust dose in renal impairment. Vancomycin is the initial treatment of choice for group B streptococcal infection in the penicillin-allergic individual.

Oritavancin (Orbactiv)

 

Oritavancin is lipoglycopeptide antibiotic that inhibits cell wall biosynthesis and disrupts bacterial membrane integrity that leads to cell death. It is indicated for treatment of acute bacterial skin and skin structure infections caused by gram-positive bacteria including S aureus (including methicillin-susceptible S aureus and MRSA), S pyogenes, S agalactiae, S dysgalactiae, S anginosus group (S anginosus, S intermedius, S constellatus) and E faecalis (vancomycin-susceptible isolates only).

Telavancin (Vibativ)

 

Lipoglycopeptide antibiotic that is a synthetic derivative of vancomycin. Inhibits bacterial cell wall synthesis by interfering with polymerization and cross-linking of peptidoglycan. Unlike vancomycin, telavancin also depolarizes the bacterial cell membrane and disrupts its functional integrity. Indicated for complicated skin and skin structure infections caused by susceptible gram-positive bacteria, including Staphylococcus aureus (both methicillin-resistant and methicillin-susceptible strains), Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus anginosus group, and Enterococcus faecalis (vancomycin-susceptible isolates only).

Dalbavancin (Dalvance)

 

Dalbavancin is lipoglycopeptide antibiotic that prevents cross-linking by interfering with cell wall synthesis. It is bactericidal in vitro against Staphylococcus aureus and Streptococcus pyogenes at concentrations observed in humans at recommended doses. It is indicated for treatment of acute bacterial skin and skin structure infections caused by Gram-positive bacteria including Staphylococcus aureus (including methicillin-susceptible and methicillin-resistant S aureus [MRSA]), S pyogenes, Streptococcus agalactiae, and the Streptococcus anginosus group (including S anginosus, S intermedius, S constellatus).

Tedizolid (Sivextro)

 

Tedizolid is an oxazolidinone antibiotic indicated for skin and skin structure infections caused by susceptible isolates of Gram-positive bacteria including Staphylococcus aureus (including methicillin-resistant [MRSA] and methicillin-susceptible [MSSA] isolates), Streptococcus pyogenes, S agalactiae, S anginosus Group (including S anginosus, S intermedius, and S constellatus), and Enterococcus faecalis. Its action is mediated by binding to the 50S subunit of the bacterial ribosome resulting in inhibition of protein synthesis.

Gentamicin (Gentacidin, Garamycin)

 

Aminoglycosides show synergy when used with penicillin for group B streptococcus. In neonates, the ill patient with sepsis and in certain situations, such as endocarditis, adding an aminoglycoside as a second drug may be helpful. The possible benefit must be weighed against the toxicity of renal and eighth nerve dysfunction, particularly in elderly people. The benefit of 2-drug therapy for group B streptococci has not been proven in terms of a better clinical outcome compared to penicillin therapy alone. The aminoglycoside needs to be tested against the isolate because only sensitive isolates can provide synergy.

Clindamycin (Cleocin)

 

Not for use as initial therapy because a small percent of group B streptococci will be resistant to clindamycin. Should not be used for endocarditis, bacteremia, or meningitis. If bacteria are sensitive, it can be used for pneumonia, osteomyelitis, and soft tissue infection. May also be useful as oral therapy to follow a course of parenteral therapy or if access becomes an issue.

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Contributor Information and Disclosures
Author

Christian J Woods, MD, FCCP Associate Program Director for Internal Medicine, Associate Program Director for Pulmonary/Critical Care, Associate MICU Director, Attending in Infectious Diseases/Pulmonary/Critical Care, MedStar Washington Hospital Center

Christian J Woods, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, Infectious Diseases Society of America

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Cubist Pharmaceuticals.

Coauthor(s)

Charles S Levy, MD Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine

Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, Oklahoma State Medical Association, Southern Society for Clinical Investigation, Association of Professors of Medicine, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Mohamad Ossiani, MD, to the development and writing of this article.

References
  1. Nandyal RR. Update on group B streptococcal infections: perinatal and neonatal periods. J Perinat Neonatal Nurs. 2008 Jul-Sep. 22(3):230-7. [Medline].

  2. Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease: a public health perspective. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1996 May 31. 45:1-24. [Medline].

  3. Huang PY, Lee MH, Yang CC, Leu HS. Group B streptococcal bacteremia in non-pregnant adults. J Microbiol Immunol Infect. 2006 Jun. 39(3):237-41. [Medline].

  4. Sendi P, Johansson L, Norrby-Teglund A. Invasive group B Streptococcal disease in non-pregnant adults : a review with emphasis on skin and soft-tissue infections. Infection. 2008 Mar. 36(2):100-11. [Medline].

  5. Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008 May 7. 299(17):2056-65. [Medline].

  6. Gardam MA, Low DE, Saginur R. Group B streptococcal necrotizing fasciitis and streptococcal toxic shock-like syndrome in adults. Arch Intern Med. 1998. 158:1704-8. [Medline].

  7. Daniels J, Gray J, Pattison H, Roberts T, Edwards E, Milner P, et al. Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness. Health Technol Assess. 2009 Sep. 13(42):1-154, iii-iv. [Medline].

  8. Lin FY, Weisman LE, Azimi P, Young AE, Chang K, Cielo M, et al. Assessment of Intrapartum Antibiotic Prophylaxis for the Prevention of Early-onset Group B Streptococcal Disease. Pediatr Infect Dis J. 2011 Sep. 30(9):759-763. [Medline]. [Full Text].

  9. Schwope OI, Chen KT, Mehta I, Re M, Rand L. The effect of a chlorhexidine-based surgical lubricant during pelvic examination on the detection of group B Streptococcus. Am J Obstet Gynecol. 2010 Mar. 202(3):276.e1-3. [Medline].

  10. Wu HM, Janapatla RP, Ho YR, Hung KH, Wu CW, Yan JJ, et al. Emergence of fluoroquinolone resistance in group B streptococcal isolates in Taiwan. Antimicrob Agents Chemother. 2008 May. 52(5):1888-90. [Medline].

  11. Bayer AS, Chow AW, Anthony BF. Serious infections in adults due to group B streptococci. Clinical and serotypic characterization. Am J Med. 1976. 61:498-503. [Medline].

  12. Berardi A, Rossi C, Lugli L, Creti R, Bacchi Reggiani ML, et al. Group B streptococcus late-onset disease: 2003-2010. Pediatrics. 2013 Feb. 131(2):e361-8. [Medline].

  13. Colford JM Jr, Mohle-Boetani J, Vosti KL. Group B streptococcal bacteremia in adults. Five years' experience and a review of the literature. Medicine (Baltimore). 1995 Jul. 74(4):176-90. [Medline].

  14. Dworzack DL, Hodges GR, Barnes WG. Group B streptococcal infections in adult males. Am J Med Sci. 1979. 277:67-73. [Medline].

  15. Farley MM, Harvey RC, Stull T. A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults. N Engl J Med. 1993. 328:1807-11. [Medline].

  16. Gallagher PG, Watanakunakorn C. Group B streptococcal bacteremia in a community teaching hospital. Am J Med. 1985 May. 78(5):795-800. [Medline].

  17. Harrison LH, Ali A, Dwyer DM. Relapsing invasive group B streptococcal infection in adults. Ann Intern Med. 1995. 123:421-7. [Medline].

  18. Jackson LA, Hilsdon R, Farley MM. Risk factors for group B streptococcal disease in adults. Ann Intern Med. 1995. 123:415-20. [Medline].

  19. Lerner PI. Meningitis caused by Streptococcus in adults. J Infect Dis. 1975. 131 Suppl:S9-16. [Medline].

  20. Lerner PI, Gopalakrishna KV, Wolinsky E. Group B streptococcus (S. agalactiae) bacteremia in adults: analysis of 32 cases and review of the literature. Medicine (Baltimore). 1977. 56:457-73. [Medline].

  21. Opal SM, Cross A, Palmer M. Group B streptococcal sepsis in adults and infants. Contrasts and comparisons. Arch Intern Med. 1988. 148:641-5. [Medline].

  22. Persson E, Berg S, Bergseng H, Bergh K, Valsö-Lyng R, Trollfors B. Antimicrobial susceptibility of invasive group B streptococcal isolates from south-west Sweden 1988-2001. Scand J Infect Dis. 2008. 40(4):308-13. [Medline].

  23. Pullen LC. Mothers may be key source of LOD Strep in neonates. Medscape Medical News. January 7, 2013. Available at http://www.medscape.com/viewarticle/777188. Accessed: March 4, 2013.

  24. Schuchat A. Group B streptococcus. Lancet. 1999 Jan 2. 353(9146):51-6. [Medline].

  25. Schwartz B, Schuchat A, Oxtoby MJ. Invasive group B streptococcal disease in adults. A population-based study in metropolitan Atlanta. JAMA. 1991. 266:1112-4. [Medline].

  26. Trivalle C, Martin E, Martel P. Group B streptococcal bacteraemia in the elderly. J Med Microbiol. 1998. 47:649-52. [Medline].

  27. Verghese A, Mireault K, Arbeit RD. Group B streptococcal bacteremia in men. Rev Infect Dis. 1986. 8:912-7. [Medline].

  28. Eden PR, Herring CF 3rd. Group B streptococcus testing. MLO Med Lab Obs. 2015 Jul. 47 (7):52. [Medline].

 
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