Ivonne
Forum Guru
Topics: 55
Posts: 1,452
|
A 29 yo G2P1, at 38 weeks gestation comes to the labor and delivery ward for painful uterine contractions. Her prenatal course is significant for a urine culture of 100 000 colonies/mm3 of group B Streptococcus. She doesn't know the result of the sensitivity, however. She has asthma for which she uses albuterol and a PMH of anaphilactic reaction after the administration of penicilline in the past. She is in the active labor phase. Which medication is the most appropriate to include during labor and delivery?
a. Cefazolin
b. Penicillin G
c. Clindamycin
d.-Erythromycin
e.-Vancomycin
Explain your answer pz
___________________
If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
|
| sprint123
Forum Guru
Topics: 129
Posts: 870
|
A and B are ruled out due to allergy..
Clindamycin/Erythromycin is the next alternative...But there is increased possibilty of resistance..so, I think it is Vancomycin
GBS in infant is a dreadful infection and hence I think we should not take chance with resistant strains.
|
| hero
Forum Elite
Topics: 37
Posts: 460
|
http://www.cdc.gov/MMWR/preview/mmwrhtml/FIGURES/...
vanco per guidelines
|
| RX 135
tormenta
Topics: 23
Posts: 522
|
c
___________________
“People don't change. For example, I'm gonna keep on repeating 'people don't change.' ”
|
| Ujk
Forum Guru
Topics: 42
Posts: 446
|
e.-Vancomycin
___________________
“When a person really desires something, all the universe conspires to help that person to realize his dream.”
|
| jasmin
Forum Junior
Topics: 7
Posts: 40
|
CDC RECOMMENDATIONS[1]:
Recommended regimens for intrapartum antimicrobial
prophylaxis for perinatal GBS disease prevention*
Recommended Penicillin G, 5 million units IV initial dose, then
2.5 million units IV every 4 hours until delivery
Alternative Ampicillin, 2 g IV initial dose, then 1 g IV every 4 hours until delivery
If penicillin-allergic
Patients not at high risk for anaphylaxis Cefazolin 2 g IV initial dose, then
1 g every 8 hours until delivery
Patients at high risk for anaphylaxis
GBS susceptible to clindamycin and erythromycin Clindamycin, 900 mg IV every 8 hrs until delivery
OR
Erythromycin, 500 mg IV every 6 hrs until delivery
Patients at high risk for anaphylaxis
GBS resistant to clindamycin or erythromycin or susceptibility unknown Vancomycin** 1 g IV every 12 hours until delivery
* Broader-spectrum agents, including an agent against GBS, may be necessary for treatment of chorioamnionitis.
History of penicillin allergy should be assessed to determine whether high risk for anaphylaxis is present. Penicillin-allergic patients at high risk for anaphylaxis are those who have experienced immediate hypersensitivity to penicillin (e.g., angioedema or urticaria) including a history of penicillin-related anaphylaxis; other high-risk patients are those with asthma or other diseases that would make anaphylaxis more dangerous or difficult to treat, such as persons being treated with beta-adrenergic-blocking agents.
If laboratory facilities are adequate, clindamycin and erythromycin susceptibility testing (Box 1) should be performed on prenatal GBS isolates form penicillin-allergic women at high risk for anaphylaxis.
Resistance to erythromycin is often but not always associate with clindamycin resistance. If a strain is resistant to erythromycin but susceptible to clindamycin, it may still have inducible resistance to clindamycin.
**Cefazolin is preferred over vancomycin for women with a history of allergy other than immediate hypersensitivity reactions, and pharmacologic data suggest it achieves effective intraamniotic concentrations. Vancomycin should be reserved for penicillin-allergic women at high risk for anaphylaxis.
|
| nany
Forum Guru
Topics: 14
Posts: 968
|
very good question Ivonne  ...,
and very good explaination jasmin
I think I'll go with Vancomycin 
___________________
" You Are Limited Only By What You Think "
|
| Ivonne
Forum Guru
Topics: 55
Posts: 1,452
|
Good job guys. The correct answer is vancomycin!
Don't take any chances with resistant strains.
___________________
If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
|
| inkspot
Forum Guru
Topics: 26
Posts: 559
|
thanks great question!
how can you find this info on cdc. i have problem searching. what key words do you people use. or is there any specific section for us the doctors where we can find the latest guidline etc. i know its kind of dumb question
___________________
Aagae Aagae Dekho hota hai kiya !!!
|
| inkspot
Forum Guru
Topics: 26
Posts: 559
|
The buzzword in this question was: She doesn't know the result of the sensitivity
___________________
Aagae Aagae Dekho hota hai kiya !!!
|
| ricardoricardo
Forum Newbie
Topics: 0
Posts: 26
|
ERYTHROMYCIN cuz she is allergic to penicillin ,, and she has a positive urine culture
indications for prophylactic GBS:
1.prelabout rupture of membraned for more than 18 hours
2.GBS positive culture
3.inta partum fever
4.history of preterm labout
|
| Markus2009
Forum Senior
Topics: 9
Posts: 189
|
Vancomycin for sure
|
|
| |
| | | | | | | | | | | | |
