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OB/GYN antibiotics
From WikEM
Contents
Mastitis
- No need to routinely interrupt breastfeeding with puerperal mastitis.
- For mild symptoms <24 hours, supportive care may be sufficient[1]
- Effective milk removal (frequent breast feeding - use pumping to augment milk removal)
- Analgesia (NSAIDs)
Antibiotics
Treatment directed at S. aureus and Strep and E. coli
- Uncomplicated mastitis → 10 days of antibiotics (regardless of MRSA suspicion)[2]
- Cephalexin 500mg PO q6hrs OR
- Clindamycin 450mg PO q8hrs (also provides MRSA coverage) OR
- Amoxicillin/Clavulanate 875mg PO q12hrs OR
- Dicloxacillin 500mg PO q6hrs OR
- Azithromycin 500mg PO x1 on day 1, then 250mg PO daily for days 2-5
Endometritis
<48hrs Post Partum
Treatment is targeted against polymicrobial infections, most often 2-3 organisms of normal vaginal flora
- Clindamycin 900mg q8hrs PLUS Gentamicin 1.5mg/kg IV q8hrs OR
- Doxycycline 100mg IV PO q12hrs daily PLUS
- Ampicillin/Sulbactam 3g IV q6hrs
- Cefoxitin 2g IV q6hrs daily
>48hrs Post Partum
- Doxycycline 100mg IV or PO q12hrs + Metronidazole 500mg IV or PO q8hrs daily
PID
- Treat all partners who had sex with patient during previous 60 days prior to symptom onset
Outpatient Options
- Ceftriaxone 250mg IM x1 + doxycycline 100mg PO BID x14d +/- metronidazole 500mg PO BID x14d [3]
- Metronidazole based upon assessment of risk for anaerobes; consider in:
- Pelvic abscess
- Proven or suspected infection w/ Trichomonas or Bacterial Vaginosis
- History of gynecological instrumentation in the preceding 2-3wks
- Metronidazole based upon assessment of risk for anaerobes; consider in:
- Cefoxitin 2 g IM in a single dose and Probenecid, 1 g PO administered concurrently in a single dose[4] + Doxycycline 100 mg PO BID x 14 days +/- flagyl based on above criteria
Alternative Outpatient Options
- Ceftriaxone 250mg IM x1 + 1 g of azithromycin per week, x 2 weeks[5] +/- flagyl based on above criteria
- A single randomized controlled trial shows that azithromycin is superior to doxycycline even when compliance in taking doxycycline is excellent (98.2% vs 87.5%)[5]
Inpatient
- Cefoxitin 2gm IV q6hr OR cefotetan 2gm IV q12hr) + doxycycline PO or IV 100 mg q12hr OR
- Clindamycin 900mg IV q8h + gentamicin 2mg/kg QD OR
- Ampicillin-sulbactam 3gm IV q6hr + doxycycline 100mg IV/PO q12hr
See Also
Antibiotics by diagnosis
- Bone and joint antibiotics
- Cardiovascular antibiotics
- ENT antibiotics
- Eye antibiotics
- GI antibiotics
- GU antibiotics
- Neuro antibiotics
- OB/GYN antibiotics
- Pulmonary antibiotics
- Skin and soft tissue antibiotics
- Bioterrorism antibiotics
- Environmental exposure antibiotics
- Immunocompromised antibiotics
- Post exposure prophylaxis antibiotics
- Pediatric antibiotics
- Sepsis antibiotics
- Arthropod and parasitic antibiotics
For antibiotics by organism see Microbiology (Main)
References
- ↑ Amir LH. ABM Clinical Protocol #4: Mastitis, Revised March 2014. Breastfeeding Medicine. 2014;9(5):239-243. doi:10.1089/bfm.2014.9984.
- ↑ Levine BL. 2011 EMRA Antibiotic Guide. EMRA. Pg 78.
- ↑ Ness RB et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 2002;186:929–37
- ↑ CDC PID Treatment http://www.cdc.gov/std/treatment/2010/pid.htm
- ↑ 5.0 5.1 Savaris RF. et al. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Obstet Gynecol. 2007 Jul;110(1):53-60
