Re: Asymptomatic bacteriuria

From: Betsy Hyde (elishyde@connix.com)
Fri Apr 21 16:10:01 2000


I guess I should have been more specific w/ my questions, so I will try again.

>
>If you've documented ASB properly, you have a culture and sensitivity in
>hand. Use the most inexpensive, noninvasive (i.e. non-systemic, if possible)
>drug you can, from the list of susceptibles. If it happens to be ampicillin,
>so be it.

We generally use macrodantin, for the reasons stated above. However, sometimes ampi happens to be the cheapest abx to which the organism is sensitive. Do any of you have concerns re overgrowth of ampicillin-resistent ecoli w/ frequent tx of ampicillin? Would you use a more expensive medication (ie a cephalosporin) to avoid this problem? Or don't you perceive it as a problem? (we've had several IUFDs due to ampi resistent ecoli sepsis, so that is what drives my questions.)

>
>If there is + GBS in the urine, then that implies a rather heavy colonization
>in vagina and rectum. Those people are declared "high risk" GBS-wise by most
>folks and treated accordingly.

right....treated in labor. But, given that it is impossible to eradicate the gi source of GBS, we see GBS UTIs that never go away.....10K, 25K...always there. Do you keep treating low levels of GBS in the urine *prior* to labor?

Hope this is more clear.

--
Betsy Hyde CNM
Branford, CT




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