Guideline for Infection and Obstetric patients

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Guideline for Infection and Obstetric patients: Pyrexia in pregnancy and labour.

Post-partum sepsis (endometritis)

If mild endometritis without signs of sepsis: Oral Co-amoxiclav 375mg tds 5 days
If more unwell, signs of sepsis or unable to take oral medication: IV Co-amoxiclav 1.2g tds converting to oral Co-amoxiclav 625mg tds when clinically improving.

If non-severe penicllin allergy: IV Cefuroxime 1.5g tds plus IV Metronidazole 500mg tds.

In severe penicillin allergy: IV Clindamycin 600mg qds for 24-48hrs then switch to oral Clindamycin 300-450mg qds for 5 days. NB: This regime does not cover Gram negatives, if patient has severe sepsis, or there is no clinical improvement after 24hrs add IV Gentamicin 1-1.5mg tds unless renal impairment. Levels need to be monitored.

Notes:

Check vaginal swabs, urine and blood culture reports to adjust antibiotics
If the patient does not respond, liaise with a medical microbiologist

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.