current pregnancy are also considered indications for prophylaxis.

FIGURE 64-5 Indications for intrapartum prophylaxis to prevent perinatal group B streptococcal (GBS)
disease under a universal prenatal screening strategy based on combined vaginal and rectal cultures
obtained at 35 to 37 weeks’ gestation. (From Centers for Disease Control and Prevention,2010.)

Risk-Based Prevention.

Intrapartum chemoprophylaxis is given to women who have any of the following: delivery < 37 weeks,
ruptured membranes ≥ 18 hours, or intrapartum temperature ≥ 100.4°F (≥ 38.0°C).

Women with GBS during the current pregnancy and women with a prior infant with invasive early-onset
GBS disease are also given chemoprophylaxis.

At Parkland Hospital in 1995—and prior to consensus guidelines—we adopted the risk-based approach
for intrapartum treatment of women at high risk.
In addition, all term neonates who were not given intrapartum prophylaxis were treated in the delivery
room with aqueous penicillin G, 50,000 to 60,000 units intramuscularly.

Intrapartum Antimicrobial Prophylaxis

Prophylaxis administered 4 or more hours before delivery is highly effective (Fairlie, 2013).
Regardless of screening method, penicillin remains the first-line agent for prophylaxis, and ampicillin is
an acceptable alternative

Women with a penicillin allergy and no history of anaphylaxis should be given cefazolin.

Clindamycin-sensitive but erythromycin-resistant isolates should have a D-zone test performed to assess
for inducible clindamycin resistance.

If clindamycin resistance is confirmed, vancomycin should be administered.

Erythromycin is no longer used for penicillin-allergic patients.

REGIMEN TREATMENT
RECOMMENDED PEN G 5 MILLION
UNITS IV INITIAL
DOSE, THEN 2.5 -
3 MILLION UNITS
IV EVERY 4 HRS
UNTIL DELIVERY