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Towers Recommends New Treatment Protocol for Preventing Neonatal Infection

Research on treatment options for pregnant women who test positive for group B streptococcus (GBS), intestinal bacteria typically harmless in adults that can cause serious illness in newborn babies, may soon lead to changed treatment protocols.

The rate of babies born with GBS has significantly dropped over the past 50 years through protocols and guidelines established by the Centers for Disease Control and the American College of Obstetricians and Gynecologists. Current guidelines recommend chemoprophylaxis treatment of mothers with penicillin during childbirth. In the presence of high-risk penicillin allergies in the mother, guidelines recommend the use of clindamycin as the antibiotic of choice, as long as there is no demonstrated resistance to clindamycin or erythromycin- a resistance that has been on the rise over the past 20 years. In the absence of sensitivity to the latter antibiotics, vancomycin is currently recommended with a dosing schedule of 1 gram intravenous every 12 hours during labor.

A study led by Craig Towers, MD, Associate Professor, Obstetrics and Gynecology, sought to obtain appropriate dosing for vancomycin. In reviewing literature on the therapy, he discovered very little information existed regarding the transplacental passage of vancomycin and the blood levels obtained in the neonate at the time of delivery. Dr. Towers initiated the largest study to date looking at the transplacental passage of vancomycin from mother to neonate. Through this study, he found that current dosing recommendations were inadequate and suggests a regimen of 20 mg of vancomycin intravenously every 8 hours with a maximum individual dose not to exceed 2 grams.

Dr. Towers presented his research findings in February at the Society for Maternal-Fetal Medicine, the largest obstetrical research meeting in the world. The study is also expected to publish in the American Journal of Obstetrics and Gynecology later this year. Dr. Towers said he believes the dosing recommendations recommended in his study will become the new treatment guidelines in the future.

Co-authors of the study include Cheryl Onwuchuruba, MD, Bobby Howard, MD, Mark Hennessy, MD, Lynlee Wolfe, MD, and Marjorie Brown, MD.

Posted April 10, 2014

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