Tratamiento para el Estreptococo Beta (Grupo B)

Tratamiento según tipo de infección

El tratamiento de primera línea para infecciones por estreptococo del grupo B (EGB) es la penicilina G o ampicilina, combinada con gentamicina en casos de sepsis o infecciones graves, según la European Heart Journal y Clinical Microbiology and Infection 1, 2
La penicilina G es el tratamiento de elección para infecciones invasivas en adultos, con una dosis de 12-20 millones de unidades/día divididas cada 4-6 horas durante 2-4 semanas, dependiendo del tipo de infección, según la European Heart Journal 1
Para pacientes alérgicos a penicilina con alto riesgo de anafilaxia, se recomienda clindamicina o vancomicina, según el American Family Physician 3

La penicilina G intravenosa es el tratamiento de elección para la profilaxis intraparto, con una dosis inicial de 5 millones de unidades, seguida de 2,5-3 millones de unidades cada 4 horas hasta el parto, según Clinical Microbiology and Infection 2
La ampicilina es una alternativa a la penicilina G, con una dosis inicial de 2g IV, seguida de 1g cada 4 horas hasta el parto, según Clinical Microbiology and Infection 2

La combinación de ampicilina y gentamicina es el tratamiento empírico inicial para la sepsis neonatal por EGB, según Clinical Microbiology and Infection y American Family Physician 2, 3
La dosis de ampicilina para neonatos es de 100-200 mg/kg/día dividida en 4-6 dosis, y la dosis de gentamicina es de 3 mg/kg/día, según Clinical Microbiology and Infection 2

La duración del tratamiento para la endocarditis por EGB es de 4 semanas, según la European Heart Journal 1
La duración del tratamiento para la meningitis por EGB es de 14-21 días, según el American Family Physician 3

Approximately 20% of GBS isolates are resistant to clindamycin, so susceptibility testing should always be performed before using this antibiotic, according to the American Academy of Pediatrics 4
All newborns with signs of sepsis should undergo a full diagnostic evaluation and receive empirical antimicrobial therapy immediately, as recommended by the American Academy of Pediatrics 4
Adequate IAP is defined as ≥4 hours of penicillin, ampicillin, or cefazolin before delivery, with guidelines supported by the American Academy of Pediatrics 4

The American Academy of Pediatrics recommends intrapartum antibiotic prophylaxis for Group B Streptococcus (GBS)-positive culture within the preceding 5 weeks, GBS bacteriuria during the current pregnancy, history of a previous infant with GBS disease, or unknown GBS status with risk factors 5
The Centers for Disease Control and Prevention indicate that adequate intrapartum antibiotic prophylaxis is defined as ≥4 hours of penicillin, ampicillin, or cefazolin before delivery 6, 7

The American College of Obstetricians and Gynecologists recommends penicillin G as the first-line treatment, with doses of 5 million units IV initially, then 2.5-3 million units every 4 hours until delivery 6, 7
For penicillin-allergic patients, the Centers for Disease Control and Prevention suggest using cefazolin if the patient is at low risk for anaphylaxis 8

The American Academy of Pediatrics recommends that all newborns with signs of sepsis require full diagnostic evaluation, including lumbar puncture if stable, and empirical IV ampicillin plus gentamicin immediately 6, 9, 5, 7, 8
Well-appearing term infants whose mothers received adequate intrapartum antibiotic prophylaxis require only observation for ≥48 hours 6, 9, 5, 7, 8

The Centers for Disease Control and Prevention note that approximately 20% of GBS isolates are resistant to clindamycin, so susceptibility testing must always be performed before using clindamycin for intrapartum antibiotic prophylaxis 6, 7
The American College of Obstetricians and Gynecologists recommends that pregnant women with a penicillin allergy history undergo skin testing for potential delabeling 8