NeoNotes Journal Club
Andrew B. Kairalla MD, Editor
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ü
Designates reiteration of
1996 CDC guidelines.
ü Ampicillin (2 g IV, then 1 g IV q4h until delivery) remains an acceptable alternative.
Ø For Penicillin-allergic women who are not at high risk for anaphylaxis, cefazolin (2 g IV, then 1 g IV q8h until delivery) is now recommended.
Ø Due to increasing resistance of GBS isolates to erythromycin and clindamycin, penicillin-allergic women who are considered to be at high risk for anaphylaxis should be given these drugs for IAP only if their GBS isolates are known to be sensitive to them.
Ø An alternative medication for IAP in women with immediate penicillin hypersensitivity is vancomycin (1 g IV q12h until delivery).
Suggested Discussion Points:
1.
Will obstetricians be willing to try cefazolin in
penicillin-allergic women who are at “low risk for anaphylaxis”?
2.
Will doing sensitivities on all positive GBS screening cultures
be cost-effective?
3.
Why vancomycin?? Especially
when hospitals are trying to restrict vancomycin use due to the emergence of
vancomycin-resistant Enterococcci.
Comment:
From a neonatal
standpoint, “adequate IAP” is defined as receiving either penicillin,
ampicillin or cefazolin at least 4 hours before delivery.
The effectiveness of IAP against GBS with other antibiotics is unknown.
Treatment started less than 4 hours before delivery or with a different
drug is considered “partial IAP”, and may effect the evaluation, treatment
or observation period required of the baby (see New Neonatal Management
section). ABK.
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