Management of Group B Streptococcus Bacteriuria

Treatment Approach Based on Pregnancy Status

The Centers for Disease Control and Prevention recommends that any concentration of Group B Streptococcus in urine during pregnancy requires intrapartum antibiotic prophylaxis, regardless of colony count, because Group B Streptococcus bacteriuria is a marker for heavy genital tract colonization and increased risk of early-onset neonatal disease 1, 2, 3, 4
If symptomatic urinary tract infection is present, treat the acute infection at the time of diagnosis with appropriate antibiotics according to standard urinary tract infection protocols, but this does not replace the need for intrapartum prophylaxis 1, 3
Penicillin G or ampicillin are the preferred agents for any Group B Streptococcus treatment due to universal susceptibility, with no Group B Streptococcus isolate ever documented as penicillin-resistant worldwide 5
Antepartum antibiotic treatment does not eliminate Group B Streptococcus colonization, and recolonization after oral antibiotics is typical, which is why intrapartum intravenous prophylaxis remains necessary even if bacteriuria was treated earlier in pregnancy 2, 4, 6, 7

The Centers for Disease Control and Prevention advises against using oral antibiotics during pregnancy thinking this eliminates the need for intrapartum prophylaxis, as Group B Streptococcus recolonization occurs rapidly, and only intravenous antibiotics given ≥4 hours before delivery are 78% effective in preventing early-onset neonatal disease 4, 6, 7, 8
The American College of Obstetricians and Gynecologists guidelines, as reported by the Centers for Disease Control and Prevention, should not be confused between pregnancy and non-pregnancy management, as the guidelines mandating treatment of any Group B Streptococcus bacteriuria apply specifically to pregnant women to prevent neonatal disease, not to non-pregnant individuals 5