Review Question - QID 106207

Intrapartum penicillin is first line treatment for patients who are vaginal or perianal carriers of Group B streptococcus (GBS).

Ten to thirty-five percent of pregnant women are asymptomatic carriers of GBS. Though the risk of sepsis is low in neonates born to GBS positive mothers, associated morbidity and mortality is high in these patients. Accordingly, carriers are treated with penicillin G during labor. Clindamycin is often used in patients with penicillin allergies.

Apgar et al. review GBS in pregnancy, writing that universal screening for GBS is more effective than dosing intrapartum antibiotics based on GBS risk factors. Women with GBS bacteriuria during the current pregnancy and those who have previously delivered a GBS septic newborn do not need screening and receive intrapartum antibiotic prophylaxis.

Clifford et al. write that the implementation of intrapartum antibiotic prophylaxis has greatly reduced neonatal GBS disease in the United States, New Zealand, and Australia. The authors argue that universal screening in the United States has more effectively reduced disease burden than the GBS risk-factor based approach used in Australia and New Zealand.

Illustration A diagrams indications for intrapartum penicillin treatment in pregnant women.

Incorrect answers:
Answers 1 and 4: Antepartum antibiotics are not given to women positive for GBS.
Answer 2: Intrapartum clindamycin is a common substitute for penicillin G in GBS positive women with penicillin allergies. However, this woman does not have any known drug allergies, so penicillin is the most appropriate first line treatment.
Answer 3: Postpartum antibiotics are not given to women positive for GBS. Doxycycline is contraindicated in pregnancy.