Streptococcus Group B Infections Medication

  • Author: Christian J Woods, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Sep 13, 2011
 

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.

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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.

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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.

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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.

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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).

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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.

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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  Attending, Section of Infectious Diseases Program, Secrion of Pulmonary and Critical Care Medicine, Georgetown University Hospital, Washington Hospital Center

Christian J Woods, MD 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, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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, and Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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 and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgments

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

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