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Common organisms: Prevotella bivia Streptococcus spp. (Grp A, Grp B) Enterobacteriaceae Chlamydia trachomatis Ureaplasma urealyticum |
Ampicillin 2g stat then 1g IV q4-6h PLUS Gentamicin 5mg/kg IV q24h PLUS Metronidazole 500mg IV q8h |
Ampicillin-sulbactam 3gm IV q6h PLUS Doxycycline 100mg PO q12h OR Clindamycin 900mg IV q8h PLUS Gentamicin 5mg/kg IV q24h |
Intravenous antibiotics are administered until the patient has improved and afebrile for 48 hours, then are typically followed by oral antibiotics to complete a 10-14 days course. |
OBSTETRIC AND GYNAECOLOGICAL INFECTIONS
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Intra-partum antibiotic prophylaxis (IAP) for Group B Streptococcus (GBS) positive mothers Indications of IAP: Previous infant with invasive GBS disease Preterm labour GBS carriage in previous pregnancy PPROM with known GBS carrier GBS carriage in current pregnancy |
Benzylpenicillin 5MU IV initial dose, Then 2.5-3MU IV q4h until delivery OR Ampicillin 2gm IV initial dose then 1 gm IV q4-6h until delivery |
Mild Penicillin allergy Cefazolin 2gm IV initial dose, then 1 gm IV q8h until delivery. OR Cefuroxime 1.5 gm IV stat and 750mg IV q8h until delivery |
Prophylaxis begins at hospital admission for labour or rupture of membrane and is continued every four hours until the infant is delivered. Treatment is NOT INDICATED if Caesarean-section performed before onset of labour with intact membrane (Please use standard surgical prophylaxis). Antenatal treatment is NOT RECOMMENDED for GBS cultured from a vaginal or rectal swab. |
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Severe Penicillin allergy Vancomycin 15-20mg/kg IV q8-12h until delivery OR Clindamycin 900mg IV q8h until delivery |
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Preterm Premature Rupture of Membrane (PPROM) |
If non-GBS carrier: Erythromycin 250mg PO q6h for 7-10 days If GBS carrier: Ampicillin 2gm IV q6h for 48 hours followed by Amoxicillin 500mg PO q8h for an additional 5-7 days or until delivery whichever comes first PLUS One dose of Azithromycin 1gm PO upon admission (to cover for Ureaplasma – important cause of chorioamnionitis and Chlamydia) |
Ampicillin 2g IV stat dose followed by 1g IV q6h |
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Chorioamnionitis |
Ampicillin 2gm stat then 1g IV q6h PLUS Gentamicin 5mg/kg IV q24h If the patient is undergoing a caesarean delivery: PLUS Metronidazole 500mg IV q8h |
Ampicillin-sulbactam 3gm IV q6h Mild Penicillin allergy: Cefazolin 2gm IV q8h PLUS Gentamicin 5mg/kg IV q24h Severe Penicillin allergy: Clindamycin 900mg IV q8h |
Antibiotic regimen is continued postpartum until patient is afebrile and asymptomatic for AT LEAST 48 HOURS. There is NO evidence that continuation with oral antibiotics is beneficial after discontinuation of parenteral therapy. |
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Common organisms: Neisseria gonorrhoeae Chlamydia trachomatis Bacteroides spp. Enterobacteriaceae Haemophilus influenzae Streptococcus spp. especially Streptococcus agalactiae (GBS) Gardnerella vaginalis Ureaplasma urealyticum Mycoplasma hominis |
Outpatient regimen (Mild-moderate): Ceftriaxone 500mg IM in a single dose OR Cefotaxime 1gm IM in a single dose
PLUS Metronidazole 400mg PO q8h for 14 days
PLUS Doxycycline 100mg PO q12h for 14 days OR Azithromycin 1gm PO once per week for 2 weeks |
Cefixime 400mg PO stat PLUS Tinidazole 2g PO stat PLUS Azithromycin 1g PO stat PLUS Fluconazole 150mg PO stat |
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Inpatient regimen (Moderate-Severe): Cefuroxime 1.5gm IV q8h OR Ceftriaxone 2gm IV q24h
PLUS Doxycycline 100mg PO q12h PLUS Metronidazole 500mg IV/PO q8h Duration of treatment: 14 days |
Ampicillin-sulbactam 3gm IV q6h PLUS Doxycycline 100mg PO q12h |
Tubo ovarian abscess:
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Endometritis |
Post-partum* Clindamycin 900mg IV q8h PLUS Gentamicin 5mg/kg IV q8h OR Metronidazole 500mg IV q8h PLUS Gentamicin 5mg/kg IV x 1dose |
Amoxicillin-clavulanate 1.2gm IV q8h OR Ampicillin-sulbactam 3gm IV q6h |
Duration of treatment: 10-14 days *For other non-pregnant endometritis – follow regimen for severe PID |
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Bacterial vaginosis |
Metronidazole 400mg PO q8h for 7 days |
Clindamycin 300mg PO q12h for 7 days |
Metronidazole can be used in any stage of pregnancy. |
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Vaginal Candidiasis Candida albicans Uncomplicated infection |
Clotrimazole 500mg as a single vaginal pessary (Stat dose) OR Clotrimazole 200mg as vaginal pessary for 3 nights |
Fluconazole 150-200mg PO for one dose |
Pregnancy: If indicated, treat with topical therapy as oral therapy is CONTRAINDICATED. |
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Vaginal Candidiasis Candida albicans Complicated infections: |
Severe vaginitis symptoms: Fluconazole 150-200mg PO q72h for 2 or 3 doses |
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Recurrent vulvovaginal candidiasis: Fluconazole 150-200mg PO q72h for 3 doses then weekly for 6 months |
Clotrimazole 500mg vaginal suppository once weekly for 6 months |
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Trichomoniasis Trichomonas vaginalis |
Metronidazole 400mg PO q8h for 7 days OR Metronidazole 2gm PO as single dose |
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Metronidazole can be used in any stage of pregnancy. If post-partum and breastfeeding, not advisable to breastfeed during treatment. May resume breastfeeding after 24 hours of the last dose. |
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Cervicitis* |
Azithromycin 1gm single dose |
Doxycycline 100mg PO q12h for 7 days |
*Watch group as preferred regimen due to single dose administration. |
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Common organisms: Staphylococcus aureus (MSSA) Streptococcus pyogenes (Group A, B) Escherichia coli, Bacteroides spp., Corynebacterium spp. CoNS |
Outpatient Cephalexin 500mg PO q6h for 5-7 days |
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Duration: 5-6 days If poor response: 10-14 days. Less severe infection: Milk culture. Severe infection (hemodynamic instability) blood culture. |
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Inpatient Cloxacillin 2gm IV q6h |
Cefazolin 1-2gm IV q8h |
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Post episiotomy tear |
1st and 2nd degree tear: Antibiotics not required |
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3rd and 4th degree tear: Cefuroxime 1.5gm IV as single dose Plus Metronidazole 500mg IV q8h |
Penicillin allergy Clindamycin 600mg IV as single dose |
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Manual removal of placenta |
Ampicillin 2gm IV as single dose Plus Metronidazole 500mg IV q8h |
Cefazolin 2gm IV as single dose Plus Metronidazole 500mg IV q8h |
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Post Lower Segment Caesarean Section (LSCS) infection |
In mild Surgical Site Infections (SSI), antibiotic is generally not indicated. Appropriate dressing is the primary treatment |
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Cloxacillin 1gm q6h OR Cefazolin 1-2gm IV q8h |
Risk of Gram-negative anaerobic infection (e.g.: Diabetes): Ampicillin-sulbactam 3gm IV q6-8h |
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Influenza in pregnancy (seasonal and H1N1) |
Oseltamivir 75mg PO q12h for 5 days |
Nebulization with Zanamivir respules (2) 5mg each, q12h for 5 days |
Prevention - single dose killed vaccine. |
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Varicella |
>20 weeks of gestation, presenting within 24 hours of the onset of rash. *Acyclovir 800mg PO 5 times a day for 7 days |
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*IV acyclovir is recommended for severe complications 24 hours from the onset of rash, antivirals are not found to be useful. |
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Acute toxoplasmosis in pregnancy |
<18 weeks of gestation at diagnosis without fetal infection *Spiramycin 1 gm oral q8h (3 weeks on / One week off) >18 weeks gestation and if amniotic fluid PCR is positive indicating fetal infection Pyrimethamine 50mg PO q12h for 2 days then 50mg q24h PLUS Sulfadiazine 75mg/kg PO q24h then 50mg/kg q12h PLUS Folinic Acid (10-20mg oral daily) for minimum of 4 weeks or for the duration of pregnancy |
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*This should be continued till delivery if there is no evidence of fetal infection or till 18 weeks when amniotic fluid PCR can be done. |
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Candidiasis Candida species |
Fluconazole 150mg PO stat single dose Intravaginal agent as cream or suppositories Clotrimazole, Miconazole, Nystatin. Intravaginal azole, single dose for 7-14 days. |
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Non-pregnant- If recurrent candidiasis, (4 or more episodes/year) 6 months suppressive therapy with Fluconazole 150mg PO once a week or Clotrimazole vaginal suppository 500mg once a week. |
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Bacterial vaginosis Polymicrobial |
Metronidazole 400mg PO q8h for 7 days OR Metronidazole vaginal gel 1 HS for 5 days OR Tinidazole 2 gm PO q24h for 3 days OR 2 % Clindamycin vaginal cream 5 gm HS for 5 days |
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Treatment of the partner with Metronidazole may be done. |
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Trichomoniasis Trichomonas vaginalis |
Metronidazole 400mg PO
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Cervicitis/ Urethritis/ Mucopurulent Gonococcal Polymicrobial |
Ceftriaxone 250mg IM single dose PLUS Azithromycin 1 gm single dose OR Doxycycline 100mg q12h for 7 days |
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Mastitis without abscess Staphylococcus aureus |
Cephalexin 500mg q6h OR Ceftriaxone 2 gm q24h OR Cefuroxime 1g IV q12h |
If MRSA- based on susceptibility pattern Clindamycin 300 mg IV q6h OR Vancomycin 1 gm IV q12h OR Teicoplanin 12mg/kg IV q12h for 3 doses then once daily for 6 doses |
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Mastitis with abscess |
Cloxacillin 1g IV q6h PLUS Metronidazole 500mg IV q8h |
If MRSA suspected Clindamycin 300mg q6h OR Vancomycin 15mg/kg IV q12h OR Teicoplanin 12mg/kg IV q12h for 3 doses then 6mg/kg once daily IV |
Drainage is necessary. |