|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Question about GBS treatment in labor vs prenatallyFrom: GIN11153@aol.comSat Aug 25 02:13:04 2007
As a longtime L&D nurse, I remember when moms were treated for GBS during pregnancy, thus attempting to avoid some of the potential complication of GBS such as PPROM, preterm labor, chorioamnionitis, etc. I don't understand the concept of why nowadays women aren't treated until they go into labor, usually weeks after the culture comes back positive which potentially could mean that the fetus is affected by the infection for at least 4-5 weeks. Someone posted these articles on another listserv that brought this topic up in my mind again-thoughts appreciated for my learning experience: Obstet Gynecol. 1997 Aug;90(2):240-Obs Persistence of penicillin G benzathine in pregnant group B streptococcus carriers. Weeks JW, Myers SR, Lasher L, Goldsmith J, Watkins C, Gall SA. Department of Obstetrics & Gynecology, Louisiana State University School of Medicine, Shreveport, USA. _jweeks1@mail.jweeks1@mjwe_ (mailto:jweeks1@mail.sh.lsumc.edu) OBJECTIVE: To determine if streptococcicidal levels of penicillin G benzathine can be detected in maternal serum 4 weeks after treatment with 4.8 million units. METHODS: Thirty-seven pregnant women with positive group B streptococcus vaginal or urine cultures were each given 4.8 million units of penicillin G benzathine. Maternal blood samples were collected after injection and at delivery. Serum penicillin levels were measured by high-pressure liquid chromatography. Follow-up cultures were done when possible. RESULTS: None of the patients had serum penicillin levels below 0.20 microgram/mL 30 days after treatment. Cord blood levels were approximately 50% lower than maternal levels. In all but three subjects, cord blood levels exceeded 0.06 microgram/mL, the minimal inhibitory concentration for group B streptococcus. The three exceptions were patients who delivered more than 100 days after treatment. Group B streptococcus cultures were negative at the time of delivery in 72% of cases. None of the patients with positive cultures were moderately or heavily colonized. CONCLUSION: In pregnant women, penicillin G benzathine levels are high enough to inhibit the growth of group B streptococcus for more than 4 weeks after injection with 4.8 million units. Further studies are needed to evaluate whether this regimen can prevent neonatal colonization and invasive group B streptococcus disease. PMID: 9241301 Am J Obstet Gynecol. 2000 Aug;183(2):372-Am Late third-trimester treatment of rectovaginal group B streptococci with benzathine penicillin G. Bland ML, Vermillion ST, Soper DE. Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston 29425, USA. OBJECTIVE: We sought to determine the efficacy of late third-trimester benzathine penicillin G administration in eradicating maternal group B streptococcal colonization at delivery. STUDY DESIGN: We performed a prospective trial of late third-trimester treatment with benzathine penicillin G versus observation in 78 obstetric patients colonized with group B streptococci. Patients were screened by use of rectovaginal swabs cultured in selective media between 34 and 37 completed weeks' gestation. Patients with positive cultures were offered antepartum treatment with 4.8 million units of intramuscular benzathine penicillin G or observation. Participants in both groups were recultured at their delivery admission before receiving standard intrapartum therapy. The primary outcome was the frequency of persistent maternal group B streptococcal colonization at the delivery admission. Other outcome variables included semiquantitative growth characteristics of all group B streptococcal cultures, the frequency of neonatal sepsis, and adverse maternal effects. Data were analyzed by the Student t test for continuous variables and the chi(2) or Fisher exact test for categoric variables, with significance established at P <.05. RESULTS: Both groups were similar with respect to selected demographics, gestational age at delivery, and frequency of heavy group B streptococcal growth in initial screening cultures. The mean interval from treatment until delivery was 19.4 +/- 7.5 days (mean +/- SD). There were no cases of neonatal sepsis in either group or any adverse maternal effects attributed to the treatment. Group B streptococcal culture characteristics at delivery admission were as follows. Positive results for group B streptococci were found in 7 (25%) treated patients and 41 (82%) patients under observation (relative risk, 0.30; 95% confidence interval, 0.16-0.59; P <.0001). Positive results for heavy growth of group B streptococci were found in 0 (0%) treated patients and 31 (62%) patients under observation (relative risk, 0.01; 95% confidence interval, 0.00-0.12; P <.0001). CONCLUSIONS: Treating group B streptococci carriers with benzathine penicillin G in the late third trimester eradicates or significantly reduces maternal group B streptococcal colonization at delivery. This may provide an adjuvant therapy to those mothers at risk for receiving inadequate intrapartum antibiotic prophylaxis against group B streptococci. PMID: 10942472 J Matern Fetal Neonatal Med. 2005 May;17(5):333-J M Efficacy of intramuscular penicillin in the eradication of group B streptococcal colonization at delivery. Pinette MG, Thayer K, Wax JR, Blackstone J, Cartin A. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine 04102, USA. OBJECTIVE: Due to rapid deliveries and human error, not all group B streptococcal positive mothers will receive adequate prophylactic antibiotic treatment in labor. We sought to determine if long acting intramuscular penicillin given after a positive culture result would be efficacious in eradicating group B streptococcal colonization at the time of delivery. METHODS: Patients positive for group B streptococci at 35-37 weeks were randomized to receive 2.4 million units of intramuscular benzathine penicillin G suspension (Bicillin L-A) versus no treatment. Study patients were recultured at the time of admission to labor and delivery prior to receiving prophylactic antibiotics according to CDC guidelines. RESULTS: A total of 53 patients were enrolled. A small but significant decrease in the rate of group B streptococcal colonization was observed in the treatment group (14/27, 52%) versus the control group (20/23, 87%), p=0.03. CONCLUSION: The large number of persistent carriers suggests that 2.4 million units of intramuscular benzathine penicillin G suspension (Bicillin L-A) is insufficient as sole therapy. However, the decline in group B streptococcal carriers might lessen the risk of failed or insufficient intrapartum treatment. Intramuscular benzathine penicillin G suspension (Bicillin L-A) may be useful as an adjunctive treatment for patients at risk for rapid delivery, before adequate intrapartum prophylaxis can be given. ---------------------------------------------------------------------------
--------------------------------------------------------------------------- Gail Neuman RNC CPHW --------------------------------------------------------------------------- student midwife and student nurse practitioner certified high risk OB Perinatal Nurse Associates 801 N. Tustin Ave., Suite 305 Santa Ana, CA 92705 (714) 314-7070 (714) 838-1479 fax
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Tue Sep 2 05:11:11 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.