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Choice of intrapartum antibiotic prophylaxis against GBS

Choice of intrapartum antibiotic prophylaxis against GBS
This approach attempts to select patients who can safely receive penicillin or a cephalosporin and reduce use of vancomycin. Penicillin allergy testing can be performed if time permits and it is unclear whether the patient has a history suggestive of a serious immediate allergy (lgE-mediated) event. A patient with a family history of penicillin allergy but no personal history is considered to be at low risk of having a serious immediate allergy. Refer to UpToDate content on penicillin allergy and anaphylaxis for more information on evaluation of patients who believe that they might be allergic to penicillin. Antibiotic doses in the table are for patients with normal renal function.
GBS: Group B streptococcus; IV: intravenous.
* Patients with a reported penicillin allergy have sometimes been given penicillins inadvertently or because a physician did not think the allergy was concerning. If tolerated, it proves the patient is not allergic to penicillins. Examples of penicillin antibiotics include penicillin V, penicillin G, dicloxacillin, nafcillin, oxacillin, cloxacillin, amoxicillin, ampicillin, and piperacillin. There are also combination drugs that contain penicillins, such as ampicillin-sulbactam, piperacillin-tazobactam, amoxicillin-clavulanate, and ticarcillin-clavulanate.
¶ Penicillin is preferred because of its narrow spectrum.
Δ Mild reactions associated with a low risk of a serious immediate allergy include isolated nausea, vomiting, headache, mild pruritus without rash, nonuticarial rash without systemic symptoms. Refer to UpToDate content on penicillin allergy and anaphylaxis for more information on evaluation of patients who believe that they might be allergic to penicillin.
In the United States, erythromycin is not recommended for GBS prophylaxis because of high rates of resistance, while clindamycin use depends upon results of susceptibility tests. If an isolate is resistant to erythromycin, it may have inducible resistance to clindamycin as well, even if it appears to be susceptible to clindamycin by standard in vitro testing methods, thus D-zone testing for inducible resistance from macrolides should be done, if possible. Refer to UpToDate content for additional information.
§ The American College of Obstetricians and Gynecologists 2020 committee opinion on prevention of GBS early-onset disease in newborns suggests weight-based vancomycin dosing.
Adapted from Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 797. Obstet Gynecol 2020; 135:e51.
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