Persistence of penicillin G benzathine in pregnant group B streptococcus carriers

Weeks, Jonathan W.; Myers, Steven R.; Lasher, Lisa; Goldsmith, Jane; Watkins, Chris; Gall, Stanley A.

doi:10.1016/s0029-7844(97)00247-0

Cited by 21 publications

(12 citation statements)

References 13 publications

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“…Another study measured maternal and fetal penicillin G levels after one intramuscular dose of penicillin G benzathine. This study showed levels above the MIC at 30 days after injection 16. Our current investigation documents penicillin G levels in the fetus using the current intravascular CDC dosing regimen.…”

Section: Discussionsupporting

confidence: 56%

Duration of Intrapartum Prophylaxis and Concentration of Penicillin G in Fetal Serum at Delivery

Barber

Zhao

Buhimschi

et al. 2008

Obstetrics &Amp; Gynecology

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OBJECTIVE Intrapartum penicillin G prophylaxis aims to prevent early-onset group B streptococci (GBS) sepsis by interrupting vertical transmission. We examined the relationship between duration of prophylaxis and fetal serum penicillin G levels among fetuses exposed to fewer than 4 hours of prophylaxis compared with longer durations. METHODS In this prospective cohort study, 98 laboring GBS-positive women carrying singleton gestations before or at 37 weeks were administered 5 million units of intravenous penicillin G followed by 2.5 million units every 4 hours until delivery. Umbilical cord blood samples were collected at delivery, and penicillin G levels were measured by high-performance liquid chromatography. Intraassay and interassay coefficients of variation were less than 3%. RESULTS Fetuses exposed to fewer than 4 hours of prophylaxis had higher penicillin G levels than those exposed to greater than 4 hours (P=.003). In multivariable linear regression analysis, fetal penicillin G levels were determined by duration of exposure, time since last dose, dosage, and number of doses, but not maternal body mass index. Penicillin G levels increased linearly until 1 hour (R2=.40) and then decreased rapidly according to a power-decay model (R2=.67). All subgroups analyzed were above the minimal inhibitory concentration (MIC) for GBS (0.1 micrograms/mL)(P<.002). Individual samples were 10–179-fold above the MIC. In patients receiving maintenance dosing, penicillin G did not accumulate in the cord blood and returned to baseline after each 4-hour interval. CONCLUSION Short durations of prophylaxis achieved levels significantly above the MIC, suggesting a benefit even in precipitous labors. The designation of infants exposed to fewer than 4 hours of prophylaxis as particularly at risk for GBS sepsis may be pharmacokinetically inaccurate.

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Section: Discussionsupporting

confidence: 56%

Duration of Intrapartum Prophylaxis and Concentration of Penicillin G in Fetal Serum at Delivery

Barber

Zhao

Buhimschi

et al. 2008

Obstetrics &Amp; Gynecology

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“…Lewin and Amstey 64 reported that treatment of colonized women and their hus- bands with benzathine penicillin/procaine penicillin injection in the third trimester was effective in reducing the colonization rate at delivery. Weeks et al 65 have recently reported a 72% reduction in GBS colonization rate and eradication of heavy GBS colonization at delivery after administration of benzathine penicillin G to women with GBS colonization at various times between 16 and 37 weeks gestation, but follow-up was unavailable for nearly a third of their subjects and no control group was studied. Now, it is generally accepted that it is extremely difficult or impossible to eradicate GBS from mucosal surfaces, 66 especially from the lower intestinal tract, 67 and that vaginal recolonization after a course of antibiotic therapy is exceedingly common, as initially reported by Hall et al 61 No studies have demonstrated an effect on neonatal infections.…”

Section: Antepartum Prophylaxismentioning

confidence: 99%

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

1999

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ABSTRACT. Objective. To identify interventions that reduce the attack rate for early-onset group B streptococcal (GBS) sepsis in neonates.Study Design. Literature review and reanalysis of published data.Results. The rate of early-onset GBS sepsis in highrisk neonates can be reduced by administration of antibiotics. Treatment during pregnancy (antepartum prophylaxis) fails to reduce maternal GBS colonization at delivery. With the administration of intravenous ampicillin, the risk of early-onset infection in infants born to women with preterm premature rupture of membranes is reduced by 56% and the risk of GBS infection is reduced by 36%; addition of gentamicin may increase the efficacy of ampicillin. Treatment of women with chorioamnionitis with ampicillin and gentamicin during labor reduces the likelihood of neonatal sepsis by 82% and reduces the likelihood of GBS infection by 86%. Universal administration of penicillin to neonates shortly after birth (postpartum prophylaxis) reduces the early-onset GBS attack rate by 68% but is associated with a 40% increase in overall mortality and therefore is contraindicated. Intrapartum prophylaxis, alone or combined with postnatal prophylaxis for the infants, reduces the early-onset GBS attack rate by 80% or 95%, respectively.Conclusions. Women with chorioamnionitis or preterm premature rupture of membranes and their infants should be treated with intravenous ampicillin and gentamicin. Intrapartum antimicrobial prophylaxis may be appropriate for other women whose infants are at increased but less extreme risk, and supplemental postpartum prophylaxis may be indicated for some of their infants. Selection of appropriate candidates and prophylaxis strategies requires careful consideration of costs and benefits for each patient. Pediatrics 1999;103(6). URL: http://www.pediatrics.org/cgi/content/full/103/6/e78; group B streptococcus, neonatal sepsis, early-onset sepsis, prevention, prophylaxis.ABBREVIATIONS. EOGBS, early-onset neonatal group B streptococcus infection; AAP, American Academy of Pediatrics; ACOG, American College of Obstetricians and Gynecologists; CDC, Centers for Disease Control and Prevention; GBS, group B streptococcus. P revention of early-onset neonatal group B streptococcal (EOGBS) sepsis requires the identification of infants who are at high risk and the use of effective preventive intervention. The American Academy of Pediatrics (AAP), 1,2 American College of Obstetricians and Gynecologists (ACOG), 3,4 and Centers for Disease Control and Prevention (CDC) 5 agree that this intervention should be intrapartum antibiotic treatment. The commentaries that accompany those recommendations and several recent cost-benefit or efficacy analyses implicitly 1-7 or explicitly 8 -11 assume that intrapartum antimicrobial prophylaxis is 100% effective, but reports of at least 50 cases of EOGBS disease in infants whose mothers received intrapartum prophylaxis [12][13][14][15] demonstrate that this cannot be correct. The decision analysis cited by the CDC recommendations 1...

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“…74 Amniotic fluid concentrations were comparable to maternal serum levels 78 and were considered sufficient to inhibit penicillin-sensitive bacteria. 72, 73, 75, 78 Based on renal elimination rates of penicillin in the 3 rd trimester, a four-hour dosing interval is considered optimal to achieve adequate amniotic fluid levels that will inhibit penicillin-sensitive bacteria. 72 …”

Section: Resultsmentioning

confidence: 99%

Prophylaxis and Treatment of Anthrax in Pregnant Women

Meaney‐Delman¹,

Rasmussen²,

Beigi³

et al. 2013

Obstetrics &Amp; Gynecology

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Objective To review the safety and pharmacokinetics of antibiotics recommended for anthrax post-exposure prophylaxis and treatment in pregnant women. Data Sources Articles were identified in the PUBMED database from inception through December 2012 by searching the keywords ([“pregnancy]” and [generic antibiotic name]). Additionally, hand searches of references from REPROTOX, TERIS, review articles and Briggs’ Drugs in Pregnancy and Lactation were performed. Methods of Study Selection Articles included in the review contain primary data related to the safety and pharmacokinetics among pregnant women of five antibiotics recommended for anthrax post-exposure prophylaxis and treatment (ciprofloxacin, levofloxacin, moxifloxacin, doxycycline, amoxicillin), and of nine additional antibiotics recommended as part of the treatment regimen (penicillin, ampicillin, linezolid, clindamycin, meropenem, doripenem, rifampin, chloramphenicol, or vancomycin). Tabulation, Integration and Results The PUBMED search identified 3850 articles for review. Reference hand searching yielded nine additional articles. In total, 112 articles met the inclusion criteria. Conclusions Overall, safety and pharmacokinetic information is limited for these antibiotics. Although small increases in risks for certain anomalies have been observed with some antibiotics recommended for prophylaxis and treatment of anthrax, the absolute risk of these antibiotics appears low. Given the high morbidity and mortality associated with anthrax, antibiotics should be dosed appropriately to ensure that antibiotic levels can be achieved and sustained. Dosing adjustments may be necessary for the beta lactam antibiotics and the fluoroquinolones to achieve therapeutic levels in pregnant women. Data indicate that the beta lactam antibiotics, the fluoroquinolones, and, to a lesser extent, clindamycin enter the fetal compartment, an important consideration in the treatment of anthrax, as these antibiotics may provide additional fetal benefit in the 2nd and 3rd trimesters of pregnancy. Additional well designed safety and pharmacokinetic studies are needed.

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Persistence of penicillin G benzathine in pregnant group B streptococcus carriers

Cited by 21 publications

References 13 publications

Duration of Intrapartum Prophylaxis and Concentration of Penicillin G in Fetal Serum at Delivery

Duration of Intrapartum Prophylaxis and Concentration of Penicillin G in Fetal Serum at Delivery

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

Prophylaxis and Treatment of Anthrax in Pregnant Women

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