Streptococcus Group B Infections Treatment & Management

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

Medical Care

Group B streptococci are uniformly sensitive to penicillin and ampicillin. Although resistance to penicillin or ampicillin has not be documented, some isolated have shown minimum inhibitory concentrations (MICs) approaching the upper limits of susceptibility for some of the beta-lactam agents.[5] Group B streptococci have never been as exquisitely sensitive to penicillin as group A beta-hemolytic streptococci; therefore, the initial therapy for group B streptococcal infection has always been high-dose parenteral penicillin or ampicillin.

Penicillin or ampicillin plus an aminoglycoside has demonstrated synergy but has not been shown to provide a better clinical outcome than penicillin or ampicillin alone. Testing for aminoglycoside sensitivity is important because synergy is not observed if the organism is not sensitive to aminoglycosides. Keep in mind that given group B streptococcal isolate can be resistant to one aminoglycoside and sensitive to another.

While clindamycin and erythromycin were at one time uniformly active against group B streptococci, resistance has been increasing. One large study that examined the susceptibility patterns of over 4800 group B streptococcal isolates found that 32% were resistant to erythromycin, 15% were resistant to clindamycin, and 99% of clindamycin-resistant strains were also resistant to erythromycin.[5] As a result, sensitivity testing is important before these agents are used. Oral clindamycin remains an excellent agent to follow a course of parenteral therapy for bone, soft-tissue, and lung infections if the isolate is susceptible.

Because of possible resistance with clindamycin, vancomycin remains the initial treatment of choice for group B streptococcal infection in patients who are allergic to penicillin. Penicillin, ampicillin, or vancomycin remains the treatment of choice for endocarditis. While vancomycin may be adequate in group B streptococcal meningitis in patient who are allergic to penicillin, skin testing and desensitization for penicillin therapy might be considered. Penicillin has not been demonstrated to be superior to vancomycin for group B streptococcal endocarditis.

While fluoroquinolones appear to have efficacy against isolates of group B streptococci, resistance to fluoroquinolones has recently been reported.[10]

Similarly, linezolid, a new antibiotic with efficacy for aerobic gram-positive cocci, should have activity against group B streptococci. It is available in parenteral or oral form. However, no clinical studies have evaluated linezolid in group B streptococcal infections.

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Surgical Care

Surgical opinion and intervention is important.

  • Pneumonia may require empyema drainage.
  • Endocarditis, bacteremia, and sepsis may require heart valve replacement.
  • Soft-tissue infection, septic arthritis, osteomyelitis, discitis, and epidural abscess often require surgery combined with parenteral antibiotics for cure.
  • Necrotizing fasciitis and septic arthritis are surgical emergencies.
  • Epidural abscess may require emergency surgery.
  • Urinary tract infection and pelvic abscess may require relief of genitourinary obstruction and abscess drainage for cure.
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Consultations

Group B streptococcal infection may require various consultations for an optimal outcome. An infectious disease specialist is often helpful in choosing the antibiotic and duration of therapy. Appropriate surgical support is critical for a good outcome.

  • Pneumonia may require a pulmonologist or surgeon for empyema drainage.
  • Bacteremia, endocarditis, and line-related sepsis may require a cardiovascular surgeon for valve replacement.
  • Soft-tissue infection, osteomyelitis, epidural abscess, discitis, and arthritis require a rheumatologist for arthrocentesis and an orthopedic surgeon or neurosurgeon for possible surgical opinion and intervention.
  • Urinary tract infection or pelvic abscess may require a urologist or gynecologist for surgical opinion and possible relief of obstruction and abscess drainage.
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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.

References

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