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#1 of 12 Old 04-10-2008, 05:43 PM - Thread Starter
 
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I am GBS +. My OB and I are searching for some sort of antibiotic that is useful for treating GBS that can be given orally or by shot. I'm trying to stay away from an IV. TIA!
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#2 of 12 Old 04-10-2008, 07:58 PM
 
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You're not going to find any research to support it. Plain old penicillin is the best (just like for strep throat) but you will need to start it now and keep taking it until the baby is born so that you do not recolonize.
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#3 of 12 Old 04-10-2008, 07:59 PM
 
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Why not just refuse to take an antibiotic at all--and only give it to the baby if the baby actually gets sick?

Antibiotic prophylaxis has a definite downside, including risk of thrush/yeast for you and baby, as well as others.

And doesn't it make sense to save medicine for the times one is actually sick? (or the baby)
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#4 of 12 Old 04-10-2008, 08:17 PM - Thread Starter
 
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To make a long story short I'm picking my battles. As of right now, the induction battle is way more important to me than this one. He's willing to at least work with me on this one.
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#5 of 12 Old 04-10-2008, 11:41 PM
 
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Um.... you don't have to battle at ALL. You are the one paying him. Stand strong. Make your own choices.

Choose not to be bullied.

-Angela
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#6 of 12 Old 04-11-2008, 02:58 AM
 
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Penicillin by IV is the gold standard, and clindamycin IV for women who are PCN allergic. The practice where I am precepting recently had a PCN allergic mom who tested GBS+ and was adamant that she have abx. Unfortunately her strain of GBS was resistant to clindamycin. The perinatologist that the midwife consulted with recommended vancomycin IM (shot), which only needs to be administered every 12 hours (versus every 4 hours for PCN). The downside is that vancomycin is a Big Gun antibiotic. Interestingly, we redid her swab to test for sensitivity to vanc and she came back GBS neg....after all that! Also, penicillian can be given IM (by shot), though it's not the recommended route for this treatment, but you could ask about that.

I was recently doing some research for a client who was interested in treating with Hibiclens, and there is some fairly robust research supporting the use of Hibiclens (chlorhexidine) vaginal washes every 6 hours in labor. A peri bottle is used to gently wash the outer genitals and lower vagina (this is not a douche) and is as effective as systemic antibiotics for decreasing transmission of GBS from mother to baby. I did not bookmark the information, but if you google "Hibiclens" or "chlorhexidine" and "group beta strep" you'll find what I'm talking about. These were clinical trials published in medical journals, so I would think your OB would be open to looking at the evidence.

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#7 of 12 Old 04-11-2008, 03:33 AM
 
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I usually run antibiotic as an in-and-out IV - it doesn't stay in the arm and only requires the mom to stay still for 5-20 minutes. Would that be an acceptible alternative? I'm guessing you're not needle-phobic since a shot is okay.

If you want the antibiotic, you can get it and then insist the IV catheter be removed afterwards if they don't know how to do it with the butterfly or don't have the right lines to do it.

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#8 of 12 Old 04-13-2008, 11:16 AM
 
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the reason the recommendation is IV is because they have tried the other treatments oral and IM. here are 2 studies on the subject of IM treatment. I also remember reading a study from a Texas hospital where the treatment was to give all newborns IM antibiotics.

Am J Obstet Gynecol. 2000 Aug;183(2):372-6.
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 [PubMed - indexed for MEDLINE]
--------------------------------------------------------------------------------------

Obstet Gynecol. 1997 Aug;90(2):240-3.

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.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 [PubMed - indexed for MEDLINE]
------------------------------------------------------------------------------------------------------------------
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#9 of 12 Old 04-13-2008, 11:29 AM
 
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personally I would recommend a hibiclens protocol in labor, in addition to what ever you decide to do, because the antibiotics are effective against only certain bacteria- mix it in a peri bottle --

140 ml of 0.2% chlorhexidine vaginal wash at the onset of labor or at rupture of membranes, whichever comes first, and to be repeated every 6 hours
Prepare the 0.2% chlorhexidine solution by combining 7 ml (1 1/2 teaspoons) Hibiclens© (4% chlorhexidine) with 133 ml (1/2 cup plus 2 teaspoons) of water.
Use the entire amount each time, and mix a fresh batch for every application.
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#10 of 12 Old 04-13-2008, 09:46 PM
 
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IM injections are very painful compared to a well-placed IV. What's your r
reason for wanting to avoid an IV?

Vanco is not ever my drug of choice, despite the 12 hour dosing, because of red-man syndrome (flushing, BP changes and generally feeling crappy) which can occur with admnistration. It also needs to run in over an hour instead of 20 minutes.

There are reasons to prophylax. I believe in prophylaxis, because I've seen GBS sepsis. But you don't need the IV line running the rest of the time and the penicillin isn't usually more than a minor annoyance while it's going in.

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#11 of 12 Old 04-14-2008, 01:04 PM
 
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I would recommend re-testing closer to your due date, and see... like one of the pps said, you might test negative. the chances of infecting the baby are so low.

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#12 of 12 Old 04-14-2008, 01:05 PM
 
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another thing to consider is your pediatrician. Some will freak out if Mom is GBS+ and does not take antibiotics. I had this scenario recently and they put baby in the hospital for about 5 days.

Good luck
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