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Antimicrobial therapy for group B streptococcal infections in neonates and young infants

Antimicrobial therapy for group B streptococcal infections in neonates and young infants
Site(s) of infection Definitive therapy Duration of therapy
GA <35 weeks GA ≥35 weeks
Bacteremia/sepsis/pneumonia
  • PNA ≤7 days
    • Penicillin G 50,000 units/kg per dose IV every 12 hours
    • Alternative – Ampicillin 50 mg/kg per dose IV every 12 hours
  • PNA ≤7 days
    • Penicillin G 50,000 units/kg per dose IV every 12 hours
    • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
10 days
  • PNA >7 days
    • Penicillin G 50,000 units/kg per dose IV every 8 hours
    • Alternative – Ampicillin 75 mg/kg per dose IV every 12 hours
  • PNA >7 days
    • Penicillin G 50,000 units/kg per dose IV every 8 hours
    • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
10 days
Meningitis
  • PNA ≤7 days
    • Penicillin G 150,000 units/kg per dose IV every 8 hours
    • Alternative – Ampicillin 100 mg/kg per dose IV every 8 hours
  • PNA ≤7 days
    • Penicillin G 150,000 units/kg per dose IV every 8 hours
    • Alternative – Ampicillin 100 mg/kg per dose IV every 8 hours
14 days*
  • PNA >7 days
    • Penicillin G 125,000 units/kg per dose IV every 6 hours
    • Alternative – Ampicillin 75 mg/kg per dose IV every 6 hours
  • PNA >7 days
    • Penicillin G 125,000 units/kg per dose IV every 6 hours
    • Alternative – Ampicillin 75 mg/kg per dose IV every 6 hours
14 days*
Other focal infections (dosing is for term infants >7 days old since these infections typically occur beyond day 7 after birth)
Cellulitis/adenitis
  • Penicillin G 50,000 units/kg per dose IV every 8 hours
  • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
10 to 14 days
Septic arthritis
  • Penicillin G 50,000 units/kg per dose IV every 8 hours
  • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
14 to 21 days
Osteomyelitis
  • Penicillin G 50,000 units/kg per dose IV every 8 hours
  • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
21 to 28 days
Urinary tract infection
  • Penicillin G 50,000 units/kg per dose IV every 8 hours
  • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
10 days
This table summarizes suggested definitive treatment regimens for group B streptococcal infections in neonates and young infants. The infant should be transitioned from empiric to definitive therapy once GBS is identified in culture, provided that the infant has improved clinically. For infants with GBS meningitis, we suggest repeat lumbar puncture at 24 to 48 hours of therapy to document sterilization of CSF before changing to penicillin or ampicillin monotherapy. The antibiotic doses listed above are for use in neonates and young infants weighing ≥1 kg with normal renal function. For additional dosing details, refer to separate pediatric and neonatal drug information monographs included within UpToDate.

GA: gestational age; PNA: postnatal age; IV: intravenous; GBS: group B streptococcus; CSF: cerebrospinal fluid.

* Complicated central nervous system infections require longer treatment.
Graphic 66906 Version 17.0

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