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Antimicrobial therapy for group B streptococcal infections in neonates and young infants[1-3]

Antimicrobial therapy for group B streptococcal infections in neonates and young infants[1-3]
Site(s) of infection Definitive therapy Duration of therapy
GA <35 weeks GA ≥35 weeks
Bacteremia/sepsis/pneumonia
  • PNA ≤7 days
    • Penicillin G 50,000 units/kg per dose IV every 12 hours
    • Alternative – Ampicillin 50 mg/kg per dose IV every 12 hours
  • PNA ≤7 days
    • Penicillin G 50,000 units/kg per dose IV every 12 hours
    • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
 10 days
  • PNA >7 days
    • Penicillin G 50,000 units/kg per dose IV every 8 hours
    • Alternative – Ampicillin 75 mg/kg per dose IV every 12 hours
  • PNA >7 days
    • Penicillin G 50,000 units/kg per dose IV every 8 hours
    • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
 10 days
Meningitis
  • PNA ≤7 days
    • Penicillin G 150,000 units/kg per dose IV every 8 hours
    • Alternative – Ampicillin 100 mg/kg per dose IV every 8 hours
  • PNA ≤7 days
    • Penicillin G 150,000 units/kg per dose IV every 8 hours
    • Alternative – Ampicillin 100 mg/kg per dose IV every 8 hours
 14 days*
  • PNA >7 days
    • Penicillin G 125,000 units/kg per dose IV every 6 hours
    • Alternative – Ampicillin 75 mg/kg per dose IV every 6 hours
  • PNA >7 days
    • Penicillin G 125,000 units/kg per dose IV every 6 hours
    • Alternative – Ampicillin 75 mg/kg per dose IV every 6 hours
 14 days*
Other focal infections (dosing is for term infants >7 days old since these infections typically occur beyond day 7 after birth)
Cellulitis/adenitis
  • Penicillin G 50,000 units/kg per dose IV every 8 hours
  • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
 10 to 14 days
Septic arthritis
  • Penicillin G 50,000 units/kg per dose IV every 8 hours
  • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
 14 to 21 days
Osteomyelitis
  • Penicillin G 50,000 units/kg per dose IV every 8 hours
  • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
 21 to 28 days
Urinary tract infection
  • Penicillin G 50,000 units/kg per dose IV every 8 hours
  • Alternative – Ampicillin 50 mg/kg per dose IV every 8 hours
 10 days
Transition from empiric to definitive therapy should occur once GBS is identified by culture and clinical improvement is evident. For infants with GBS meningitis, we suggest repeat lumbar puncture at 24 to 48 hours of therapy to document sterilization of CSF before changing to penicillin or ampicillin monotherapy. The antibiotic doses listed above are for use in neonates and young infants weighing ≥1 kg with normal renal function. For additional dosing details, refer to the Lexicomp pediatric and neonatal drug information monographs included within UpToDate.
GA: gestational age; PNA: postnatal age; IV: intravenous; GBS: group B streptococcus; CSF: cerebrospinal fluid.
* Complicated central nervous system infections require longer treatment.
References:
  1. American Academy of Pediatrics. Group B streptococcal infections. In: Red Book: 2018 Report of the Committee on Infectious Diseases, 31st ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Itasca, IL 2018. p.762.
  2. Medications. In: Guidelines for Acute Care of the Neonate, 26th Ed, Fernandes CJ, Pammi M, Katakam L (Eds), Baylor College of Medicine, Houston, TX 2018. p.228.
  3. Puopolo KM, Lynfield R, Cummings JJ, et al. Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics 2019; 144.
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