Post-partum infection and/or Suspected endometritis
Septic shock or severe sepsis
Stable patient: post-partum infection and/or Suspected endometritis
Suspected endometritis and/or postpartum infection
Includes:
- Endometritis, suspected, post partum
- Retained placenta and evidence of infection
- Post partum haemorrhage and fever
- Wound infection, post partum: typically surgical site infection (post LSCS) or Perineal infection (including post instrumental delivery and episiotomy)
Review antibiotics daily, treat 3-5 days
Preferred includes penicillin allergy non-severe:
cefazolin* 2g iv tds AND metronidazole 400mg po tds (or 500mg iv tds if oral not possible)
*Caution: Prothrombin time, INR and APTT may increase on cefazolin treatment courses, please monitor. For more information see Cefazolin associated coagulation disorders
Alternative for severe penicillin allergy:
gentamicin** 5mg/kg iv (Gentamicin is for a maximum of 3 days) AND clindamycin 600mg iv tds
**Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring. See monographs for dose banding, dose frequency and monitoring.
MRSA positive: ADD to the above antibiotics teicoplanin 12mg/kg iv (see teicoplanin monograph for dose banding, dose frequency and monitoring)
Oral options and IV to oral switch
· Preferred, including for mild penicillin allergy: cefalexin 1g tds po +/- metronidazole 400mg tds po
· Alternative, for severe penicillin allergy: clindamycin 450mg tds po
For MRSA positive patients: co-trimoxazole 960mg po bd
- For breastfeeding patients: Avoid co-trimoxazole in known G6PD deficiency, hyperbilirubinaemia and in jaundiced infants because of risk of kernicterus. In these situations discuss with Micro/ID.
Treatment after 3rd degree or 4th degree tear of perineum
Typically 3 days treatment
Preferred: (including non-severe penicillin allergy) cefalexin 1g tds po (including mild penicillin allergy) + metronidazole 400mg tds po
Alternative: (including for severe penicillin allergy or if MRSA positive) co-trimoxazole 960mg bd po
- For breastfeeding patients: Avoid co-trimoxazole in known G6PD deficiency, hyperbilirubinaemia and in jaundiced infants because of risk of kernicterus. In these situations discuss with Micro/ID.