GBS Status: Unknown

Just curious, does your L&D treat GBS unknown pts with prophylactic abx? If not, what is your protocol for your newborns of GBS uk moms?

We do treat unknown pt's at my hospital. Usually Amp 2 grams Q 6 or if they are allergic to PCN we use Cleocin 900 mg Q 8. One group of MD's that I work with treats everyone and they don't check GBS status.

If you go to the American Academy of Pediatrics website, you can access the algorhythm for the management of GBS positive women. There are defined paths in treating preterm, and term GBS pos women. You can also get the info from the CDC website.

We do amp 2g, then amp 1g q4h until delivery for unknowns. (Cleocin for PCN-allergic moms).

If they refuse, they are made aware that the baby will get IV abx after delivery. I've only had one unknown patient refuse tx so far.

Amp 2gm loading dose... then 1gm q 4h until delivery...

You can view the CDC reccomendations here... http://www.cdc.gov/groupBstrep/gbs/hospitals_guidelines.htm

Just curious, does your L&D treat GBS unknown pts with prophylactic abx? If not, what is your protocol for your newborns of GBS uk moms?

Usually, we will try to get at least 2 grams of Pen G in them before delivery...not always possible. (If they are allergic to PCN, we give Cleocin) Then, the baby will have to be monitored for at least 48 hours. That is...unless GBS comes back negative, but usually it does not come back before 48 hours unless it just happened to have been done like 2 days before mom came in for labor. That means that sometimes Mom will be d/c'd (for vag del) and have to wait on baby to get out of OBS period for GBS:unk.

If you go to the American Academy of Pediatrics website, you can access the algorhythm for the management of GBS positive women. There are defined paths in treating preterm, and term GBS pos women. You can also get the info from the CDC website.

I know what the management of positive GBS is, however, I have found that some hospitals in this area do not treat unknown GBS. So I was just curious to find out what other hospitals are doing.

If the GBS is unknown and mom does not get atleast 2 doses of antibiotics prior to delivery, the infant is not discharge until he/she is 48 hrs of age. Some moms are still inpatients and some got to boarder status with just the baby admitted.

We follow the CDC algorhythms for GBS management- so no, if a woman is GBS unknown, she does not automatically receive antibiotics in labor at my facility; we only treat if risk factors are present

Just curious, why are there so many still using Amp for GBS prophylaxis instead of PCN? PCN is the drug of choice and should be used if available. I have read literature and have attended conferences where perinatologists and the legal community have stated that there is liability if Amp is used instead of PCN (and PCN is readily available) and the baby ends up sick. We used AMP for years, and I think someone in a practice read the same literature, and boom.....PCN was in. We use cleocin for those with allergies. PCN 5 million units first dose and then 2.5 million units q4 until delivery. If two doses aren't given within 4 hours of delivery, then the baby stays 48 hours for observation.

We do have one practice that does not treat unknown GBS and >37 weeks.

I know what the management of positive GBS is, however, I have found that some hospitals in this area do not treat unknown GBS. So I was just curious to find out what other hospitals are doing.

So sorry.

We generally DO treat unknown GBBS... I guess most of our docs say beter safe than sorry. We use Amp because (as I understand it) it is more readily available. The CDC says "Penicillin remains the first-line agent for intrapartum antibiotic prophylaxis, with ampicillin an acceptable alternative." We also treat if there are intra partum risk factors.

Depending on the ped, unknown GBBS and inadequately treated GBBS babies get a CBC and blood cultures. One of our peds gets a CBC on ALL GBBS babies regardless of whether Mom was treated or not. NO GBBS baby leaves prior to 48hrs.

So sorry.

Please don't apologize! I'm sorry if I sounded like I was being snippy.

I have a hard time expressing what I am looking for sometimes, and after reading my OP, I can see my question was kind of vague.

Hey, thanks for the website! It is a new one to me, and I found the algorithm to be very helpful!