Endometritis or chorioamnionitis

Review Sepsis in Obstetrics guideline on the intranet.

Send blood cultures (10mls of blood in each bottle).

Antimicrobial recommendations antenatal and intrapartum

Treatment duration = IV + oral = 7 days total

Recommended Antibiotic

Cefuroxime 1.5g every 8 hours IV

AND

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV if oral route not available)

Severe sepsis with hypotension

ADD

Gentamicin as permn Sepsis in Obstetrics guideline.

AND

Clindamycin 600mg every 6 hours

Anaphylaxis to penicillins or allergy to cephalosporins

Clindamycin 600mg every 6 hours IV

AND

Gentamicin as per Sepsis in Obstetrics guideline.

MRSA positive

Add vancomycin as per NHS Lothian intranet calculator select trough level of 15-20mg/ml

Antimicrobial recommendation postpartum

Total duration = IV + oral = 7 days

Recommended Antibiotic

Co-amoxiclav 1.2g every 8 hours IV

Severe sepsis with hypotension

ADD

Gentamicin as per NHS Lothian intranet calculator if on or after day 3 post partum otherwise follow guidance on Sepsis in Obstetrics guideline.

AND

Clindamycin 600mg every 6 hours IV

Penicillin allergy (non-severe)

Cefuroxime 1.5g every 8 hours IV

AND

Metronidazole 400mg every 8 hours orally (500mg every 8 hours IV where oral route is not available)

Severe sepsis with hypotension

ADD

Gentamicin as per NHS Lothian intranet calculator if on or after day 3 post partum otherwise follow guidance on Sepsis in Obstetrics guideline.

AND

Clindamycin 600mg every 6 hours

Penicillin anaphylaxis or cephalosporin allergy

Clindamycin 600mg every 6 hours IV

AND

Gentamicin as per NHS Lothian intranet calculator if on or after day 3 post partum otherwise follow guidance on Sepsis in Obstetrics guideline.

MRSA positive

Add vancomycin use NHS Lothian AMT calcualtor and aim for trough levels 15-20mg/ml

IV to oral switch

Cefalexin 500mg every 8 hours

AND

Metronidazole 400mg every 8 hours

In postpartum

Co-amoxiclav 625mg every 8 hours