Guideline for the prevention of neonatal Group B Streptococcal infection

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Guideline for the prevention of neonatal Group B Streptococcal infection.

Group 1: Previous infant with GBS disease, Positive GBS in previous pregnancy, Mother has had GBS in urine or found incidentally on vaginal swab in current pregnancy

Treatment in labour.

Known carriers of Group B streptococcus should be offered IV antibiotics during labour.
Ideally, IV antibiotics should be started at least 2 hours prior to delivery for maximum benefit.
Risks and benefits must be assessed as well as the wishes of the mother.
- Benzylpencillin IV 3g stat then IV 1.2g 4 hourly until delivery
- If penicillin-allergic, Clindamycin IV 900mg 8 hourly until delivery.
NB This dosing has been agreed with microbiology, it is acknowledged that this is a slight variance with RCOG recommendations

Term prelabour rupture of membranes (>37 weeks gestation):

Start IV antibiotics (as per treatment in labour) immediately
Counsel that augmentation should not be delayed (recent trails suggest that immediate augmentation is not associated with worse maternal outcomes.

Pre-term prelabour rupture of membranes (<37 weeks gestation)

Management should be discussed with a consultant obstetrician

In absence of signs of infection GBS carriage would not usually change the management outlined in the guideline for pre-term labour. Where intervention is considered appropriate, these women should receive:

Oral Erythromycin 250mg qds for 10 days or until labour/delivery if sooner
Intrapartum prophylaxis (at least 2 hours prior to delivery) with Benzylpencillin IV 3g stat then IV 1.2g 4 hourly until delivery or if penicillin-allergic: Clindamycin IV 900mg 8 hourly until delivery
Betamethasone 12mg x 2 doses 24 hours apart, if less than 34 weeks gestation.
If chorioamnionitis is suspected change too antibiotics with a broader spectrum. See chorioamnionitis page.
Repeat swabs should be taken after completing the course.
If Group B streptococcus persists, discuss with microbiology.

Click here for the full text of the guideline.

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.