Streptococcus Group B Infections Treatment & Management
- Author: Christian J Woods, MD, FCCP; Chief Editor: Michael Stuart Bronze, MD more...
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. 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. 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.
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.
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.
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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