Group B streptococcal infection

Start treatment immediately if a senior clinical decision-maker makes a diagnosis of suspected sepsis. Follow your local protocol (e.g., Sepsis Six or Surviving Sepsis Campaign 1-hour care bundle) for investigation and treatment of all patients with suspected sepsis, or those at risk, within 1 hour.[89]Daniels R, Nutbeam T, McNamara G, et al. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011 Jun;28(6):507-12. https://emj.bmj.com/content/28/6/507.long http://www.ncbi.nlm.nih.gov/pubmed/21036796?tool=bestpractice.com SCCM and ESICM: Surviving Sepsis Campaign - pediatric patients Opens in new window

First-line treatment: rapid administration of penicillin G or ampicillin plus gentamicin.

Patients with penicillin allergy: a second- or third-generation cephalosporin (e.g., cefuroxime, cefotaxime, or ceftriaxone) may be appropriate depending on the type of allergy, or a glycopeptide (e.g., vancomycin) with or without gentamicin.[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com

Treatment course: minimum of 10 days. Duration will vary according to clinical presentation, risk of complications, and initial response to therapy.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

First-line treatment: penicillin G or ampicillin plus gentamicin.

Patients with penicillin allergy: consult infectious-disease specialist, as the presentation is rare and management complicated.

Treatment course: 14 to 21 days.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

First-line treatment: penicillin G or ampicillin.

Patients with penicillin allergy: a second- or third-generation cephalosporin may be appropriate depending on the type of allergy, a macrolide (e.g., clarithromycin), or a glycopeptide (e.g., vancomycin).[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com

Treatment course: minimum of 10 days.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

First-line treatment: penicillin G or ampicillin.

Patients with penicillin allergy: a second- or third-generation cephalosporin may be appropriate depending on the type of allergy, or a glycopeptide (e.g., vancomycin) with or without gentamicin in selected cases.[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com

Treatment course: 3 to 4 weeks.

Treatment recommended for ALL patients in selected patient group

Joint must be aspirated and a formal washout in operating room strongly considered.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

First-line treatment: cefuroxime plus metronidazole, or ampicillin/sulbactam with or without gentamicin.

Patients with penicillin allergy: a cephalosporin may be appropriate depending on the type of allergy, plus metronidazole.[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com Other regimens may be used, but an infectious-disease specialist should be consulted.

Infection is often polymicrobial.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

Start treatment immediately if a senior clinical decision-maker makes a diagnosis of suspected sepsis. Follow your local protocol (e.g., Sepsis Six or Surviving Sepsis Campaign 1-hour care bundle) for investigation and treatment of all patients with suspected sepsis, or those at risk, within 1 hour.[89]Daniels R, Nutbeam T, McNamara G, et al. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011 Jun;28(6):507-12. https://emj.bmj.com/content/28/6/507.long http://www.ncbi.nlm.nih.gov/pubmed/21036796?tool=bestpractice.com SCCM and ESICM: Surviving Sepsis Campaign - adult patients Opens in new window

First-line treatment: rapid administration of penicillin G or ampicillin.

Patients with penicillin allergy: a second- or third-generation cephalosporin may be appropriate depending on the type of allergy, or a glycopeptide (e.g., vancomycin).[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com

Treatment course: minimum of 10 days. Duration will vary according to clinical presentation, risk of complications, and initial response to therapy.

Treatment recommended for SOME patients in selected patient group

Gentamicin may be considered as adjunctive therapy in selected cases according to sensitivities.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

First-line treatment: penicillin G or ampicillin.

Patients with penicillin allergy: consult infectious disease specialist, as the presentation is rare and management complicated.

Treatment course: 14 to 21 days.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

First-line treatment: penicillin G or ampicillin.

Patients with penicillin allergy: a second- or third-generation cephalosporin may be appropriate depending on the type of allergy, a glycopeptide (e.g., vancomycin), a macrolide (e.g., clarithromycin), clindamycin, or a quinolone with an appropriate spectrum of activity (e.g., levofloxacin).[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com

Clinicians should be aware that fluoroquinolones have been associated with disabling and potentially irreversible musculoskeletal or nervous system adverse events.[91]US Food & Drug Administration. FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. Mar 2018 [internet publication] https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics [92]European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. 19 March 2019 [internet publication]. https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products In addition, the Food and Drug Administration has issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[93]US Food & Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. Jul 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-reinforces-safety-information-about-serious-low-blood-sugar-levels-and-mental-health-side [94]US Food & Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. Dec 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-increased-risk-ruptures-or-tears-aorta-blood-vessel-fluoroquinolone-antibiotics

Treatment course: 10 days.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

First-line treatment: penicillin G or ampicillin.

Patients with penicillin allergy: a second- or third-generation cephalosporin may be appropriate depending on the type of allergy, a glycopeptide (e.g., vancomycin), linezolid, a macrolide (e.g., clarithromycin), or a quinolone with an appropriate spectrum of activity (e.g., levofloxacin).[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com

Clinicians should be aware that fluoroquinolones have been associated with disabling and potentially irreversible musculoskeletal or nervous system adverse events.[91]US Food & Drug Administration. FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. Mar 2018 [internet publication] https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics [92]European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. 19 March 2019 [internet publication]. https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products In addition, the Food and Drug Administration has issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[93]US Food & Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. Jul 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-reinforces-safety-information-about-serious-low-blood-sugar-levels-and-mental-health-side [94]US Food & Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. Dec 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-increased-risk-ruptures-or-tears-aorta-blood-vessel-fluoroquinolone-antibiotics

Treatment course: 10 days.

Treatment recommended for SOME patients in selected patient group

Rifampin or gentamicin may be considered as adjunctive therapy in selected cases, but seek advice from an infectious-disease specialist.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

First-line treatment: penicillin G or ampicillin.

Patients with penicillin allergy: a second- or third-generation cephalosporin may be appropriate depending on the type of allergy, clindamycin, or a glycopeptide (e.g., vancomycin).[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com

Treatment course: 3 to 4 weeks.

Treatment recommended for SOME patients in selected patient group

Gentamicin may be added as an adjunctive therapy in selected cases, but seek advice from an infectious-disease specialist.

Treatment recommended for ALL patients in selected patient group

Joint must be aspirated and a formal washout in operating room strongly considered.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.

First-line treatment: amoxicillin or ampicillin.

Patients with penicillin allergy: trimethoprim, or nitrofurantoin. A cephalosporin may be appropriate depending on the type of allergy, or a quinolone with an appropriate spectrum of activity (e.g., levofloxacin).[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com

Clinicians should be aware that fluoroquinolones have been associated with disabling and potentially irreversible musculoskeletal or nervous system adverse events.[91]US Food & Drug Administration. FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. Mar 2018 [internet publication] https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics [92]European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. 19 March 2019 [internet publication]. https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products In addition, the Food and Drug Administration has issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[93]US Food & Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. Jul 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-reinforces-safety-information-about-serious-low-blood-sugar-levels-and-mental-health-side [93]US Food & Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. Jul 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-reinforces-safety-information-about-serious-low-blood-sugar-levels-and-mental-health-side

Treatment course: 3 to 7 days.

First-line treatment: penicillin G or ampicillin with or without gentamicin.

Patients with penicillin allergy: a second- or third-generation cephalosporin may be appropriate depending on the type of allergy, or a quinolone with an appropriate spectrum of activity (e.g., levofloxacin), or a glycopeptide (e.g., vancomycin) with or without gentamicin.[90]Pichichero ME. A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. Pediatrics. 2005 Apr;115(4):1048-57. http://www.ncbi.nlm.nih.gov/pubmed/15805383?tool=bestpractice.com

Clinicians should be aware that fluoroquinolones have been associated with disabling and potentially irreversible musculoskeletal or nervous system adverse events.[91]US Food & Drug Administration. FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. Mar 2018 [internet publication] https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-warnings-oral-and-injectable-fluoroquinolone-antibiotics [92]European Medicines Agency. Quinolone- and fluoroquinolone-containing medicinal products. 19 March 2019 [internet publication]. https://www.ema.europa.eu/en/medicines/human/referrals/quinolone-fluoroquinolone-containing-medicinal-products In addition, the Food and Drug Administration has issued warnings about the increased risk of aortic dissection, significant hypoglycemia, and mental health adverse effects in patients taking fluoroquinolones.[93]US Food & Drug Administration. FDA reinforces safety information about serious low blood sugar levels and mental health side effects with fluoroquinolone antibiotics; requires label changes. Jul 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-reinforces-safety-information-about-serious-low-blood-sugar-levels-and-mental-health-side [94]US Food & Drug Administration. FDA warns about increased risk of ruptures or tears in the aorta blood vessel with fluoroquinolone antibiotics in certain patients. Dec 2018 [internet publication]. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-increased-risk-ruptures-or-tears-aorta-blood-vessel-fluoroquinolone-antibiotics

Treatment course: 14 days.

Treatment recommended for ALL patients in selected patient group

All patients, regardless of age, should receive supportive therapy.

The major goal is to restore and maintain normal respiratory, cardiac, and neurologic function.

Initial assessment should follow the principles of pediatric and adult advanced life support, with evaluation of the patient's airway, breathing, and circulatory status, with secure large-caliber intravenous catheters established for giving fluids.

Patients with symptoms of compensated shock or respiratory distress should receive supplemental oxygen. Those with decompensated shock, hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Cardiopulmonary support may be needed in an intensive-care setting.