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SMFM: High Rate of Inappropriate Vancomycin Prophylaxis in Labor and Delivery
Women given prophylactic vancomycin for perinatal group B streptococcal disease may lack clear indications for the antibiotic, investigators said here.
In a single-center study, there were one or more deviations from the CDC protocol for intrapartum vancomycin in 82 of 87 patients, Linda Pelaez, M.D., of Weill Cornell Medical College in New York, reported at the Society for Maternal-Fetal Medicine meeting.
Most of the deviations involved failure to perform sensitivity testing for clindamycin and erythromycin before starting vancomycin. Unclear or undocumented penicillin allergy accounted for most of the other protocol violations.
Given the emerging threat of vancomycin-resistant organisms, physicians should make every effort to adhere to CDC guidelines, the investigators concluded.
"I think a lot of [the deviations] relate to practitioners' not being familiar with the CDC guidelines," said Dr. Pelaez. "I think the problem starts at the time of [group B streptococcus] culture. "When you do GBS culture at 35 weeks, if you don't send off for sensitivities, you're automatically not adhering to the guidelines."
"A lot of it also has to do with physicians' being apprehensive to give a patient a cephalosporin when the history elicits some sort of allergy to penicillin," she added.
Published in 2002, the CDC guidelines for group B streptococcal prophylaxis recommend that vancomycin be reserved for penicillin-allergic patients with documented resistance to clindamycin or erythromycin. Adherence to the guidelines had not been carefully examined, said Dr. Pelaez.