Group B strep sepsis remains a major cause of neonatal morbidity and mortality.  Recently, the Centers for Disease Control has changed its policy and recommends the following preventive approach. 

 

Screen patients near term for Group B strep.  The appropriate technique involves swabbing the lower third of the vagina and the perianal area.  The clinics choosing this technique should confirm appropriate collection and laboratory processing procedures for the ascertainment of Group B strep.

 

 

1.       Document any history of prior infant with GBS sepsis on problem list.  These patients will automatically be treated with antibiotics during labor. Therefore, screening them at 35-37 weeks is unnecessary and no treatment needs to be given in the antepartum period.

 

2.               GBS bacteriuria should be treated if detected on any urine culture and documented as “GBS+” on problem list.  Patient will be treated with antibiotics during labor and do not need screening at 35-37 weeks.

         

          3.       Patients scheduled for c-section do not require GBS screening.      

 

          4.       Screen all other patients at 35-37 weeks gestation by swabbing the lower third of the vagina and the perineal area.  If positive, no treatment is required until the patient presents in labor.

 

 

          1.       Pen VK 500 mg qid x 7 days

2.               Amoxicillin - 500 mg tid x 7 days

3.               Macrobid – 100 mg po bid x 7 days

4.       Keflex 500 mg tid x 7 days

 

 

 

 

 

Prepared in conjunction with the

Division of Maternal-Fetal Medicine

Duke University Medical Center

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ACOG Committee Opinion, No 173, June 1996.  Prevention of early-onset Group B Streptococcal Disease in Newborns.

 

CDC Prevention of Perinatal Group B Streptococcal Disease: a public health perspective.  MMWR 1996; 45 (RR-7):

 

 

The Clinical Care Guidelines Development Committee of the Perinatal Improvement Board of Duke University Health System has developed a series of multi-disciplinary protocols to offer guidance to health care providers who are caring for pregnant women with high risk conditions.

 

These protocols are designed to assist health care providers in the management of a variety of problems that occur in pregnancy and the time of delivery. They should not be interpreted as standard of care, but instead represent only general guidelines for the care of pregnant women with high risk conditions.  We recognize that services offered by individual providers depend not only on their training, experience and institutional resources, but on the medical facts and circumstances of the specific care situation.

The protocols remain the intellectual property of the Duke University Health System.  They cannot be reproduced in whole or part without the expressed permission of the Health System.

 

These protocols are reviewed by the Department of Obstetrics and Gynecology Division of Maternal-Fetal Medicine, the Department of Pediatrics Division of Neonatology and the Department of Anesthesiology Division of Women’s Anesthesia.  Please contact Andra H. James (andra.james@duke.edu), Chair, Clinical Care Guidelines Development Committee of the Perinatal Improvement Board with ideas for additional protocols.