II. Management: Antibiotics

  1. Common Protocol
    1. Ampicillin 2 g IV every 6 hours
    2. Gentamycin 1.5 mg/kg (Maximum 80-100 mg) q8 hours
      1. Adjust dosing per kinetics if >1-2 days use
  2. Alternative Medications
    1. Mezlocillin 3 grams IV every 4 hours
    2. Piperacillin 3 grams IV every 4 hours
    3. Timentin 3.1 grams IV every 6 hours
    4. Unasyn 3 grams IV every 4-6 hours

III. Management: Antibiotics added anaerobic coverage

  1. Indications
    1. Cesarean Section
    2. Foul amniotic discharge
  2. Agents
    1. Clindamycin 900 mg IV every 6 hours
    2. Flagyl 15 mg/kg IV load then 7.5 mg/kg IV q6 hours

IV. Management: Antibiotics added Chlamydia coverage

  1. Indications
    1. Late onset Endometritis (>48 hours postpartum)
    2. Chlamydia culture positive
  2. Agents
    1. Zithromax 1 gram PO x1 dose
    2. Erythromycin 500 mg PO qid for 7 days
    3. Erythromycin Ethylsuccinate (EES)
      1. Dose: 800 mg PO qid for 7 days
    4. Doxycycline 100 mg PO bid
      1. Do not use intrapartum or in Lactation

V. Management: Antibiotics if postpartum hematoma present

  1. Indications
    1. Must be after delivery
    2. Endometritis and postpartum hematoma
  2. Agents (choose 2)
    1. Doxycycline (not during pregnancy) AND
    2. Gentamicin (preferred) or Cefoxitin or Ampicillin/sulbactam (or as otherwise directed by local sensitivities)
  3. References
    1. Swadron, Schmitz, Bridwell, Carius in Herbert (2019) EM:Rap 19(3): 12-4

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