Penicillin allergy should be assessed in detail during antenatal care to determine whether high risk for anaphylaxis is present.
Record Penicillin Allergy on the patient’s laboratory requisition and request susceptibility testing on Group B streptococcus-positive urine and vaginal/rectal swab cultures in women who are thought to have significant risk of anaphylaxis from penicillin. Clindamycin and erythromycin susceptibility testing should be performed on prenatal GBS isolates from penicillin-allergic women at high risk for anaphylaxis.
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.
Those who have experienced immediate hypersensitivity to penicillin or a cephalosporin. For example: