There is no routine screening for antenatal Group B Streptococcus (GBS) carriage in the UK. However where GBS is identified from clinical urine/vaginal samples, peri-partum antimicrobial therapy is advised. The changing pattern of antimicrobial resistance among GBS, particularly for macrolides/lincosamides, has implications for peri-partum antimicrobial for beta-lactam allergic patients.


We undertook a retrospective observational study at a central London teaching hospital to investigate GBS antimicrobial resistance and peri-partum prescribing between 1st April 2016 and 31st March 2019.


939 obstetric patients had GBS identified at Chelsea & Westminster Hospital during the study period. 31% (279(263 resistant and 16 intermediate)/900) were erythromycin resistant and 27% (246/911) clindamycin resistant. 5.6% (51/900) had incongruent erythromycin/clindamycin resistance, presumed erm mediated.

390 women received peri-partum antimicrobials for GBS. The majority of patients received benzylpenicillin therapy (70.2%, 274/390), with cefuroxime (23.1%, 90/390), clindamycin (5.6%,22/390) and teicoplanin (1%,4/390) based therapies also used. 40.9% (9/22) were given clindamycin despite known GBS resistance.


Our data support the national guidelines, with high erythromycin/clindamycin resistance reported locally. Updated UK guidelines for GBS colonised patients recommend the use of vancomycin for beta-lactam allergic patients. Yet where sensitivities are known, clindamycin may still be used for 70% of beta-lactam allergic patients. Vancomycin, more challenging to administer and monitor, can be reserved for beta-lactam allergic, clindamycin resistant GBS carriers which account for a minority of the population (2.8%). Developing a working pathway implementation is challenging as evident with the inappropriate clindamycin use in 9 patients locally.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.

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