A 28-year-old pregnant woman is found to have a beta-lactam allergy documented as anaphylaxis. She requires treatment for Streptococcus agalactiae (Group B Strep) colonization before delivery. Which is the safest alternative?
- A Azithromycin
- B Clindamycin (if GBS susceptible) ✓
- C Vancomycin
- D Ciprofloxacin
Correct answer: B. Clindamycin (if GBS susceptible)
Explanation
Current guidelines recommend clindamycin as the first alternative for penicillin-allergic patients with high-risk allergy (anaphylaxis), provided susceptibility testing confirms GBS sensitivity, because 15–20% of GBS strains are clindamycin-resistant. If GBS is resistant to clindamycin or susceptibility is unknown, vancomycin is the fallback. Azithromycin is not recommended for GBS intrapartum prophylaxis; fluoroquinolones are avoided in pregnancy due to cartilage effects.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.