Recommended IAP regimen

1. Penicillin G (5 million units IV initial dose, then 2.5 million units IV Q4h) is recommended for most patients.

2. In women with non-immediate-type penicillin-allergy, cefazolin (Ancef, 2 g initial dose, then 1 g Q8h) is recommended.

3. Patients at high risk for anaphylaxis to penicillins are treated with clindamycin (900 mg IV Q8h) or erythromycin (500 mg IV Q6h) as long as their gBs isolate is documented to be susceptible to both clindamycin and erythromycin.

4. For patients at high risk for anaphylaxis and a GBS resistant isolate (or with unknown susceptibility) to clindamycin or erythromycin, vancomycin (1 g Q12h) should be given.

5. Antibiotic therapy is continued from hospital admission through delivery.

E. Approach to threatened preterm delivery at <37 weeks of gestation: A patient with negative GBS cultures (after 35 weeks of gestation) should not be treated during threatened labor. If GBS cultures have not been performed, these specimens should be obtained and penicillin G administered as above; if cultures are negative at 48 hours, penicillin can be discontinued. If such a patient has not delivered within four weeks, cultures should be repeated.

F. If screening cultures taken at the time of threatened delivery or previously performed (after 35 weeks of gestation) are positive, penicillin should be continued for at least 48 hours unless delivery supervenes. Patients who have been treated for >48 hours and have not delivered should receive IAP as above when delivery occurs.

References: See page 184.

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