| 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 | Cefoxitin 2g IV q6h | For severe PCN allergy: If GBS negative or clindamycin-sensitive GBS: PLUS If GBS positive and clindamycin resistant/resistance unknown: PLUS | Antibiotics are continued for one dose after delivery unless the patient is diagnosed with endometritis
| |
Chorioamnionitis (Cesarean delivery) | Bacteroides Prevotella bivia Group B & A streptococci Enterobacteriaceae M. hominis | Cefoxitin 2g IV q6h | For severe PCN allergy: Regardless of GBS status: PLUS PLUS | Continue antibiotics until afebrile for 24 hours. If fever persists, refer to endometritis guidance Dosing can be continued at recommended interval, even if peri-operative prophylaxis with a cephalosporin is given (no need to postpone a cefoxitin dose) | |
| Endometritis | Bacteroides Prevotella bivia Group B & A streptococci Enterobacteriaceae M. hominis | Cefoxitin 2g IV q6h | For severe PCN 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 cefoxitin or clindamycin/gentamicin switch to piperacillin/tazobactam. Wait 48 hours on an antibiotic regimen before considering regimen failed. |
Patient Population:
Adult