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Re: list 1114: mult topicsFrom: Garry E. Siegel, M.D. (garrys123@aol.com)Tue Jul 29 21:21:51 1997
At Tue, 29 Jul 1997, Geffrey Klein wrote: > >I would use clinda in the pen allergic patient. If not pen allergic, I >would use Pen G load with 2.4 million units IV and then 1.2 million >units iv q hr hr until delivery. > >New questions.. > >1) If a patient has been treated for carriage state in a prior pregnancy >would you treat her in subsequent pregnancies? Would you even culture >her? If you did and she was negative would you not treat her? > >2) If a GBS neg mom is ruptured 18+ hrs, would you treat her? > >-- >Geffrey H. Klein, MD >Department of Obstetrics and Gynecology >MacGregor Medical Association >Clear Lake OB Office >2200 Nasa Road One Suite 200 >Houston, Texas 77058 >713 741 2273 x2628 > >>Group B Strep >>We do the R/V culture on specific GBBS media at 36 weeks (even if history >>of GBBS or planned C/S). Treat with Amp in labor or Clindamycin as G Klien >>wrote. I'm not certain why Amp was chosen rather than Pen - I wasn't >>present at the discussions... > I'm on vacation, on AOL, and I can't see the text Geff wrote to edit; sorry. Anyway, If someone is a known carrier, and even if treated, I would still treat her in labor, and find no reason to ever culture her again. Geff, if someone who is culture negative is ruptured for 18 hours, I would re-culture then, and treat, because this is a high risk situation for GBS passage, and we all know that some of the people who are negative at the 36 week culture are positive later. Someone said that they do not culture those who are having scheduled sections; I disagree, and would culture them in case they present in labor and elect to deliver vaginally, or don't have time for a section but do have time for antibiotics. A GBS question for all: In a carrier who is scheduled for a section at 39 weeks for a known breech, and assuming you normally use a single dose of a first generation cephalosporin for routine prophylaxis, what and when do you use for this patient?
-- Garry E. Siegel, M.D. Roswell, Ga. but in Hilton Head Island on vacation with a laptop
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