Do oral abx affect GBS test results?

[Greaseball]

Some of the things I have read suggest that taking an oral antibiotic every day for a week before the GBS test will produce a negative result. But then other things say that overuse of antibiotics can actually cause a positive result.

I don't have the uncomfortable side effects that some do with abx, probably because I became immune to them some time ago. With #1 I had the IV in the hospital and neither dd nor I had the nursing problems or yeast infections that some people do.

I have an ongoing penecillin prescription, so I can always get a refill with no questions asked. (My dentist insists on it since I have a heart murmur.)

So does it sound like a good idea or a bad one?

[KKmama]

Why can't you take the test, take the antibiotics if positive, and then be retested? That makes a lot more sense to me. Are you in a situation where a + is going to affect where you can birth and/or your status with your caregiver?

I'm very much against non-necessary use of antibiotics (I'm not in the medical or health care field, but I'm a microbiologist). I don't think it's good for you (or the ground water) in the long run.

To be honest, I think eating yogurt daily is a better idea. Very safe, and some reports that it's helpful on this front...

[Defenestrator]

Oral antibiotics do influence GBS test results, if they are antibiotics that GBS is sensitive to (and penicillin would usually be one). However, it has been shown that they do not affect death rates from GBS. As I understand it, the abx kill enough of the bacteria to produce a negative test, but those that survive are now antibiotic resistant and respond less to treatment after the birth. The difference between a prenatal course of abx and a labor iv is that by the time the iv therapy is discontinued, the baby is out and cannot be exposed to maternal GBS anymore. So, if your goal is to impact the test, then the abx would most likely work, but if your goal is to avoid transmission, then they make things worse.

[KKmama]

Thank you, Defenestrator. Your post was much clearer than mine (pregnancy brain, anyone?). Everything she said is right on.

[Greaseball]

I can still have the home birth even if I'm +; I'd just rather not be +! I'll have to see an additional provider just to get a prescription for the injectable abx, but it's not something I couldn't do.

So maybe it's not a good idea...I'll just stick with the garlic and yogurt.

I don't know what the midwife's policy is on retesting.

[sarahwebb]

Defenestrator,

Do you have references or more information?

I tested positive, took a ten day course of oral antibiotics and retested negative with my first baby. I had planned to do the same thing this time, but now I'm concerned. I would definitely like more information.

Best,
Sarah

[ared1]

I don't get it. I thought GBS was a surface bacteria. I know that you can carry it in your intestines and bowels but under narmal circumstances it was harmless? We all have several types of surface bacteria we carry. How then does taking an antibiotic help if it is something we have? Sorry, I am really confused. I have never tested positive for it so I guess I really never bothered to read up more. :blush

[momadance]

I went for my first prenatal appointment at the MW office and she told me since I tested positive with DS I would automatically be required to have an IV while in labor. They don't even re-test in a 2nd pregnancy. I was so angry at that.Needless to say that was my first and last app. with her.

With DS I was given the IV while in labor and he still became sepsis after delivery and required a 2 week dose of anbx twice a day by a shot. Unbeleivable!

NOt this time!

I've been eating yogurt and probiotic foods everyday. I'm not due until Oct. and I wont take the test.

[Defenestrator]

I am having a bit of a hard time finding the abstracts that I had stored in my files about this, so I have a bit more general reference than what I would like. This is from the march of dimes website:

Taking oral antibiotics prior to labor is not recommended, as it is not effective in preventing GBS infection in the newborn. (Some studies found that 20 to 70 percent of women treated with oral antibiotics during the third trimester still carried the bacterium at labor and delivery.)

Here is the url if you want to read more:


http://www.marchofdimes.com/professionals/681_1205.asp


This is how I understand the whole anti-prenatal-antibiotics arguement.

Penicillin and its close relatives are the preferred antibiotics for the treatment of GBS. They produce a good result with the fewest side effects and lowest cost. When you take an oral antibiotic like penicillin to treat GBS, you can't continue indefinitely (say on a 4-5 week course) because of resistance issues and side effects. So, you would most likely be recommended a 10-14 day course. It is quite possible that there will be remaining bacteria after the 10-14 day course, but most likely their numbers will have been diminished. So, when you retest at the end of the course, most likely the test will come up negative. However, this does not mean that there are no bacteria in the vagina or rectum, only that there are not enough present at the test site to register on the test. If there are remaining bacteria, they can build up colonization again before labor and potentially infect the newborn. As an added danger, these bacteria are now antibiotic-resistant strains, making treatment potentially more difficult if there is transmission to the baby.

It is not the way that the antibiotics are administered that leads to the problems, but the timing. Oral antibiotics in early labor can be a good idea, as can intramuscular injections. But the gap between the prenatal oral antibiotics and the birth is what creates the potential problem.

IMHO, which I know nobody asked for . . .

I like the idea of using alternative treatments, like tea tree oil suppositories, boric acid, colloidal silver, echinacea, vitamin c, garlic, usnea, etc. (for some great suggestions read the Mothering article on GBS) instead of antibiotics and then retesting to see if some kind of impact has been made, but then continuing the treatment until birth. That way, if little or no impact on colonization has been made, a mom can make an informed choice whether or not to receive antibiotics at birth but will not have an increased risk of antibiotic-resistant GBS.

I work in homebirth in an alegal state. We have no access to iv antibiotics, so if moms who have GBS concerns (risk factors, +test or just worries) and want to remain at home, we usually treat in labor with chlorhexidine washes. This treatment has been shown in a few studies to reduce transmission at about the same rate as antibiotics in all but the most serious cases of GBS, when the amniotic sac itself is infected. It is not perfect, but it is also almost completely side-effect-free. If you are birthing within the hospital system, the hospital protocols might prevent you from using chlorhexidine in labor (because the iv antibiotics are standard treatment) but out of hospital, many midwives might be open to it.

Good luck to everyone.

[Greaseball]

I went for my first prenatal appointment at the MW office and she told me since I tested positive with DS I would automatically be required to have an IV while in labor. They don't even re-test in a 2nd pregnancy. I was so angry at that.Needless to say that was my first and last app. with her.

I don't agree with the policy of treating women as "diseased" all their lives. I was + with #1 and my midwife is convinced I will test negative this time. I don't know if she does retests, but I don't think I will use the abx to prevent another +. If you do a search for all the GBS threads they have all sorts of natural remedies, so I'm going to try as many of those as I can starting 2 weeks before the test.

[robugmum]

For what its worth, I tested positive with ds in 1999 and negative with dd in 2001. I 'm really glad they let me take the test again, I would have been very pissed off if I had been denied the second test!:wave

[Defenestrator]

As I understand it, the CDC recommendation is to not bother with a retest if there is a history of transmission to a baby. This makes sense to me because if you had one sick baby you would probably not want to take chances with a potentially unreliable screening test the second time around. That doesn't mean that a mom couldn't look at her own circumstances and make a well-informed choice to decline the test or choose something other than the standard treatment.

This is totally different, though, from what a lot of providers do, which is to declare that moms who had a previous positive test should be assumed to be positive this pregnancy. Every pregnancy is different and sometimes you can look at a whole list of contributing factors like diet, stress, other immune challenges, exhaustion, etc. that might have existed in a previous pregnancy and be lessened in this one. If there has been a big gap between pregnancies, it is possible that a mom could have a totally different health picture than she did previously. If the test is valid at all (and I know there is some question about its accuracy), then it makes sense to retest and use the most current test as the most valid.

Take care, everyone.

[tinyshoes]

This doesn't asnwer your spec. ? but:

What about skipping the test?

I opted to be tested in '01, was +, had IV abx, then thrush probs.

Opted for no test this time in '03, choosing instead to be treated based on risk factors. I wrote up and signed a document to this effect.

I decided, even if I tested - in '03, I would choose IV abx if risk factors developed during labor.

HTH

[Defenestrator]

Oops -- the extra special code in my previous post is courtesy of my 4 year old. I thought it all got deleted.

[goodcents]

I tested positive the first time around with my regular ob/gyn.

I talked about it with a midwife who recommended that I use tea tree vaginal suppository for 10 days prior plus eat some live antiobiotic cultures and test again. I didnt end up doing these as my docs wouldnt retest ( I know I could have fought but I didnt).

Anyway grease - thought you might want that info.

[Greaseball]

I've thought of the suppositories but the idea of sticking something in there other than, you know...it just seems weird! But I do have some tea tree oil and I've thought of just wiping the whole genital area with a rag soaked in the diluted oil.

[pamamidwife]

I don't test routinely, but I do know that even IV antibiotics in labor have been not too effective at reducing GBS affected infants. So, to me, oral antibiotics wouldn't be very effective in keeping GBS away. Then, you also have the huge risk of thrush, etc., in the early postpartum period.

There have been a couple solid studies shown that an injection to the BABY immediately after birth with Penicillin (NOT an IV) has GREATLY reduced GBS affected infants. (There are some that believe that GBS infection in a baby occurs PRIOR to labor/birth/membranes rupturing, not after...I tend to believe this, but also know that vaginal exams are routinely done in the hospital and at home - even after the water breaks - and this really increases any sort of infection risk with numerous bacteria!)

I just had a transfer into my practice of a mom that tested GBS positive at 30 weeks. We opted not to treat her at all and have just watched baby closely. Of course, I did not do any vaginal exams prenatally, nor during labor, and her labor was relatively quick without any signs of infection from her or baby.

It was hard for me to have the results and know that she was GBS positive. It was the first time in my practice that I knew the GBS status of a client (all of my clients receive full informed choice about prenatal screening and all to date have opted to NOT be tested). Knowing her status made me think a bit differently, but not much more than I would with any other client.

I second Defenestrator's Hibiclens washes. I hear that they have some solid backing in Europe!

[momsmyjob]

I have a ?:

I tested - with all 6 of my pregnancies but with my 7th I tested + I was shocked, not knowing what to do I just follwed the Dr.s advice of oral antibiotics and then IV antibiotics during labor.

I've searched and searched for a midwife around here but there don't seem to be any. So I'm looking for a different Dr. this time.

So my ? do I mention to this Dr. about the + in my previous pregnancy or do I not mention it and see how the test comes out. If I don't mention it and it does come out +, should I follow the same method as I did with my last baby.

TIA

[pamamidwife]

Mary, I think if you want to treat the GBS, then you should mention it. If you don't want to be treated, then don't mention it.

I've heard of providers routinely testing for GBS in the urine without telling their patients/clients. It could end up being tested for anyway.

[Greaseball]

Why do they do the rectal swab? It doesn't make sense. I hear that women who have GBS in the rectum are likely to get it in the vagina, but wouldn't that only happen with some sloppy sexual practices or poor hygiene?

[pamamidwife]

Yeah, the idea being that if you have it highly colonized in your rectum, then there is a good chance it could be colonized in your vagina. It's not too far to travel for eager bacteria!

I've heard some things about using urine samples to test for GBS. I'm not sure about it, or about the rapidness of the test, but there are some studies to show that GBS in the urine result in a higher rate of GBS affected babies.