| Diagnosis | Common Pathogens | Drug(s) of First Choice | Alternative Drug(s) | Comments | Expected Duration |
|---|---|---|---|---|---|
Chorioamnionitis (vaginal delivery) | Bacteroides Prevotella bivia Group B & A streptococci Enterobacteriaceae M. hominis | Ceftriaxone PLUS | For severe beta-lactam allergy: If GBS negative or clindamycin-sensitive GBS: PLUS If GBS positive and clindamycin resistant/resistance unknown: PLUS | Antibiotics are continued for one dose of each antibiotic after delivery unless the patient is diagnosed with endometritis
| |
Chorioamnionitis (Cesarean delivery) | Bacteroides Prevotella bivia Group B & A streptococci Enterobacteriaceae M. hominis | Ceftriaxone PLUS | For severe beta-lactam allergy: Regardless of GBS status: PLUS PLUS | Antibiotics are continued for one dose of each antibiotic after delivery unless the patient is diagnosed with endometritis Dosing can be continued at recommended interval, even if peri-operative prophylaxis with a cephalosporin is given (no need to postpone a ceftriaxone dose) | |
| Endometritis | Bacteroides Prevotella bivia Group B & A streptococci Enterobacteriaceae M. hominis | Ceftriaxone PLUS | For severe beta-lactam allergy: Vancomycin PLUS Gentamicin PLUS Metronidazole | If test for chlamydia is positive add azithromycin or doxycycline. | Continue antibiotics until afebrile for 24-48 hours. If still febrile > 48 hours on antibiotics postpartum: If on ceftriaxone/metronidazole or gentamicin switch to piperacillin/tazobactam. Wait 48 hours on an antibiotic regimen before considering regimen failed. |
Patient Population:
Adult