Managing Complications in Pregnancy and Childbirth: - IAWG

C-36 Antibiotic therapy• As a first defense against serious infections, give a combination ofantibiotics:- ampicillin 2 g IV every 6 hours;- PLUS gentamicin 5 mg/kg body weight IV every 24 hours;- PLUS metronidazole 500 mg IV every 8 hours.Note: If the infection is not severe, amoxicillin 500 mg by mouthevery 8 hours can be used instead of ampicillin. Metronidazole canbe given by mouth instead of IV.• If the clinical response is poor after 48 hours, ensure adequatedosages of antibiotics are being given, thoroughly re-evaluate thewoman for other sources of infection or consider altering treatmentaccording to reported microbial sensitivity (or adding an additionalagent to cover anaerobes, if not yet given).• If culture facilities are not available, re-examine for pus collection,especially in the pelvis, and for non-infective causes such as deepvein and pelvic vein thrombosis. Consider the possibility ofinfection due to organisms resistant to the above combination ofantibiotics:- If staphylococcal infection is suspected, add:- cloxacillin 1 g IV every 4 hours;- OR vancomycin 1 g IV every 12 hours infused over 1hour;- If clostridial infection or Group A haemolytic streptococci issuspected, add penicillin 2 million units IV every 4 hours;- If neither of the above are possibilities, add ceftriaxone 2 g IVevery 24 hours.Note: To avoid phlebitis, the infusion site should be changed every3 days or at the first sign of inflammation.• If the infection does not clear, evaluate for the source of infection.For the treatment of metritis, combinations of antibiotics are usuallycontinued until the woman is fever-free for 48 hours. Discontinueantibiotics once the woman has been fever-free for 48 hours. There isno need to continue with oral antibiotics, as this has not been provento have additional benefit. Women with blood-stream infections,however, will require antibiotics for at least 7 days.