Pyrexia of unknown source in pregnancy

Antimicrobial prescribing: NHS Lothian
NHS Lothian

Review the Sepsis in Obstetrics guideline available on the intranet.

Send blood cultures (10mls blood in each bottle)

Antenatal antimicrobial recommendations

Treatment duration = IV + oral = 7 days

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)
Penicillin allergy

Clindamycin n600mg every 6 hours IV

AND

Gentamicin IV see Sepsis in Obstetrics guideline for dosing

 

MRSA positive

  • Add vancomycin using NHS Lothian AMT intranet calculator choose trough level of 15-20mg/ml.

Cefuroxime and clindamycin are associated with C.diff infection.

Postpartum antimicrobial recommendations

Total duration = IV + oral = 7 days
Antibiotic recommendation

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
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 using NHS Lothian AMT intranet calculator choose trough level of 15-20mg/ml.

Co-amoxiclav, cefuroxime and clindamycin are associated with C.diff infection.