Treatment of Streptococcus agalactiae (Group B Streptococcus) Urinary Tract Infection

Introduction to Treatment Guidelines

The American College of Obstetricians and Gynecologists recommends that all pregnant patients with GBS bacteriuria at any concentration require treatment of the acute UTI and mandatory intrapartum IV antibiotic prophylaxis during labor 1
The Infectious Diseases Society of America recommends against treating asymptomatic bacteriuria in non-pregnant patients, as this leads to unnecessary antibiotic exposure and potential adverse effects without clinical benefit 3, 2

For uncomplicated symptomatic UTI in non-pregnant patients without penicillin allergy, the European Urology guidelines recommend ampicillin 500 mg orally every 8 hours for 7-10 days or penicillin G 500 mg orally every 6-8 hours for 7-10 days 2, 1
For complicated UTI or systemic symptoms in non-pregnant patients, the European Urology guidelines recommend initial therapy with ampicillin 2 g IV every 4-6 hours, then transition to oral therapy once clinically stable 2

The American College of Obstetricians and Gynecologists recommends that pregnant patients with GBS bacteriuria receive intrapartum IV antibiotic prophylaxis during labor, with penicillin G 5 million units IV initially, then 2.5-3.0 million units IV every 4 hours until delivery 1
For pregnant patients with penicillin allergy, the American College of Obstetricians and Gynecologists recommends cefazolin 2 g IV initially, then 1 g IV every 8 hours until delivery, or clindamycin 900 mg IV every 8 hours until delivery if susceptible 1

The Centers for Disease Control and Prevention recommend that intrapartum prophylaxis be administered ≥4 hours before delivery for maximum effectiveness, resulting in a 78% reduction in early-onset neonatal GBS disease 1
The Infectious Diseases Society of America recommends against using clindamycin without susceptibility testing, as resistance rates vary widely (3-77%) 1