Obstetrics and Gynaecology
Sepsis 6+1 for maternity patients
Image reproduced from the NCEC National Clinical Guideline No. 26 on Sepsis Management in Adults (including maternity) 2021
Antenatal Infections / Prophylaxis / Sepsis
Differentials |
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Tests to send |
Bloods
Microbiology
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Pause before prescribing |
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Comments |
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Indication |
Obstetrics - Chorioamnionitis / Sepsis - Source Unclear 18,21-23 |
First Line Antimicrobials |
Benzylpenicillin 2.4g QDS IV AND Gentamicin 5mg/kg once daily IV AND Metronidazole 500mg TDS IV |
Penicillin Allergy Alternatives |
DELAYED-onset Penicillin Hypersensitivity Cef-TRI-axone 2g daily IV AND Gentamicin 5mg/kg once daily IV AND Metronidazole 500mg TDS IV IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Clindamycin 900mg TDS IV AND Gentamicin 5mg/kg once daily IV Note : If GBS resistant to clindamycin has been isolated, replace clindamycin with vancomycin 25mg/kg loading dose (max 2g), followed by 15mg/kg BD IV AND metronidazole 500mg TDS IV. |
Comments |
|
Indication |
Obstetrics - Listeriosis / Septic Miscarriage 18,21 |
First Line Antimicrobials |
Amoxicillin 2g four hourly IV AND Gentamicin 5mg/kg once daily IV AND Metronidazole 500mg TDS IV |
Penicillin Allergy Alternatives |
Vancomycin 25mg/kg loading dose (max 2g), followed by 15mg/kg BD IV AND Gentamicin 5mg/kg once daily IV AND Metronidazole 500mg TDS IV |
Indication |
Obstetrics - Pre-term Pre-labour Rupture of Membranes (PPROM) 21,23 |
First Line Antimicrobials |
Prophylactic antibiotics recommended if > 20 weeks gestation, clinically well and no evidence of chorioamnionitis or maternal sepsis: Benzylpenicillin 2.4g QDS IV x 48 hrs (8 doses) AND Azithromycin 1g STAT PO Followed by: Amoxicillin 250mg TDS PO x 5 days |
Penicillin Hypersensitivity |
Azithromycin 1g STAT PO |
Comments |
|
Duration |
Duration as outlined above. Duration should not extend beyond labour to the post-partum period. |
Indication |
Obstetrics - Severe Life-Threatening Antenatal Sepsis – Source Unclear 18,21,22 Definition of Severe Sepsis: Sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion |
First Line Antimicrobials |
Meropenem 1g TDS IV AND Clindamycin 1.2g QDS IV NB. Use meropenem with great caution and close clinical monitoring if history of immediate-onset or severe penicillin hypersensitivity – approximately 1% risk of immediate-onset hypersensitivity to meropenem in patients with history of immediate-onset penicillin hypersensitivity. NB. Always contact Consultant Microbiologist for advice and if alternative antimicrobial choice required. |
Indication |
Obstetrics - Urinary Tract Infections - Asymptomatic Bacteriuria or Cystitis 18,21,24,25 |
First Line Antimicrobials |
Nitrofurantoin 50mg QDS PO (if < 36 weeks gestation) OR Cefalexin 500mg TDS PO (if > 36 weeks gestation) |
Penicillin Allergy Alternatives |
DELAYED-onset Penicillin Hypersensitivity Nitrofurantoin 50mg QDS PO (if < 36 weeks gestation) OR Cefalexin 500mg TDS PO (if > 36 weeks gestation) IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Nitrofurantoin 50mg QDS PO (if < 36 weeks gestation) OR Fosfomycin 3g STAT PO (if > 36 weeks gestation) |
Comments |
|
Duration |
7 days |
Indication |
Obstetrics - Urinary Tract Infections – Pyelonephritis 18,21 |
First Line Antimicrobials |
Ceftriaxone 2g daily IV +/- if severe Gentamicin 5mg/kg once daily IV |
Penicillin Allergy Alternatives |
DELAYED-onset Penicillin Hypersensitivity Cef-TRI-axone 2g daily IV +/- if severe Gentamicin 5mg/kg once daily IV IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Contact Consultant Microbiologist for advice. |
Comments |
|
Duration |
10 – 14 days |
Peripartum Infections / Prophylaxis
Indication |
Obstetrics - Pyrexia in Labour > 38°C 14,15,18,21-23 |
First Line Antimicrobials |
Benzylpenicillin 3g STAT IV then 2.4g QDS IV AND Gentamicin 5mg/kg once daily IV AND Metronidazole 500mg TDS IV |
Penicillin Allergy Alternatives |
DELAYED-onset Penicillin Hypersensitivity Cef-UR-oxime 1.5g QDS IV AND Gentamicin 5mg/kg once daily IV AND Metronidazole 500mg TDS IV IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Clindamycin 900mg TDS IV AND Gentamicin 5mg/kg once daily IV Note : If GBS resistant to clindamycin is isolated, replace clindamycin with vancomycin 25mg/kg loading dose (max 2g), followed by 15mg/kg BD IV AND metronidazole 500mg TDS IV. |
Comments |
NB . If the patient does not respond to initial empiric treatment or is severely unwell, contact Consultant Microbiologist for advice. |
Postnatal Infections / Sepsis
Indication |
Obstetrics - C-section Wound Infection / Endometritis / Perineal Infection / Pelvic Infection post-ERPC – Mild 18,21 |
First Line Antimicrobials |
Co-amoxiclav 625mg TDS PO |
Penicillin Allergy Alternatives |
DELAYED-onset Penicillin Hypersensitivity Cefalexin 500mg TDS PO AND Metronidazole 400mg TDS PO IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Clindamycin 450mg QDS PO |
Comments |
|
Duration |
5 - 7 days |
Indication |
Obstetrics - C-section Wound Infection / Endometritis / Perineal Infection / Pelvic Infection post-ERPC / Infected Third or Fourth Degree Tear – Moderate to Severe 18,21 |
First Line Antimicrobials |
Co-amoxiclav 1.2g TDS IV AND Gentamicin 5mg/kg once daily IV N.B. Check lab system for resistant organisms (e.g. MRSA, ESBL). If colonised with resistant organisms or at risk of resistance, contact the clinical microbiology team to discuss alternative antibiotic cover. |
Penicillin Allergy Alternatives |
DELAYED-onset Penicillin Hypersensitivity Cef-UR-oxime 1.5g QDS IV AND Metronidazole 500mg TDS IV AND Gentamicin 5mg/kg once daily IV IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Clindamycin 900mg TDS IV AND Gentamicin 5mg/kg once daily IV |
Duration |
Minimum 7 days based on C&S results and clinical response |
Indication |
Obstetrics - Mastitis – Mild 18,21 |
First Line Antimicrobials |
Flucloxacillin 500mg QDS PO |
Penicillin Allergy Alternatives |
DELAYED-onset Penicillin Hypersensitivity Cefalexin 500mg TDS PO IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Clindamycin 450mg QDS PO |
Duration |
7 days |
Indication |
Obstetrics - Mastitis/Breast Abscess – Severe 18,21 |
First Line Antimicrobials |
Flucloxacillin 2g QDS IV |
Penicillin Allergy Alternatives |
DELAYED-onset Penicillin Hypersensitivity Cef-UR-oxime 1.5g QDS IV IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Vancomycin 25mg/kg loading dose (max 2g), followed by 15mg/kg BD IV AND Clindamycin 900mg TDS IV (Review clindamycin at 48hrs) |
Comments |
|
Indication |
Obstetrics - Nipple and Breast Thrush 18,21,34-36 |
First Line Antimicrobials |
Nipple treatment for mother: Miconazole 2% cream applied to nipples and areolae after each feed for 1 to 2 weeks. It is not necessary to wash the cream from the nipples before the next breastfeed - any excess cream should be wiped away. Oral treatment for baby: Miconazole oral gel smeared around inside of mouth four times a day after feeds for 2 weeks. NB . Apply the gel in small amounts with a clean finger and do not use a spoon due to the risk of the baby choking on the viscous fluid. If symptoms of pain do not improve or deep breast pain develops, oral treatment of mother with fluconazole may be necessary in addition to topical treatment: Loading dose fluconazole 200mg PO, followed by 100mg daily PO for a total of 10 days of treatment. |
Duration |
Topical treatment for mother and baby should continue until 7 days after symptoms have disappeared. Fluconazole PO: 10 days. |
Comments |
|
Indication |
Obstetrics - Severe Life-Threatening Postnatal Sepsis – Source Unclear 21,37 Definition of Severe Sepsis: Sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion. |
First Line Antimicrobials |
Meropenem 1g TDS IV AND Clindamycin 1.2g QDS IV NB. Use meropenem with great caution and close clinical monitoring if history of immediate-onset or severe penicillin hypersensitivity – approximately 1% risk of immediate-onset hypersensitivity to meropenem in patients with history of immediate-onset penicillin hypersensitivity. NB. Always contact Consultant Microbiologist for advice and if alternative antimicrobial choice required. |
Comments |
|
Malaria in Pregnancy
Indication |
Obstetrics - Severe Malaria in Pregnancy 26-29 > 2% of red blood cells parasitised or end organ damage |
Likely organisms |
P. falciparum |
Antimalarial Treatment |
First Line Therapy for Severe Malaria – All Trimesters: Artesunate IV 2.4mg/kg at 0h, 12h, 24h, then daily **Please note Quinine IV is no longer available (Jul 2019)** Switch to oral therapy after at least 24 hours of IV therapy, once patient improving and can tolerate oral medication: Artemether-Lumefantrine (Riamet®) 20mg/120mg, 4 tablets at 0h, 8h, 24h, 36h, 48h and 60h N.B. Please note the timing of Riamet® doses relates to time from time zero – see worked example below:
N.B. Contact Pharmacy Department prior to discharge to ensure continuity of supply as Riamet® is not readily available in the community. OR Quinine Sulphate 600mg TDS PO to complete total of 7 days PLUS start Clindamycin 450mg TDS PO for 7 days. |
Comments |
Malaria is a medical emergency. Always discuss with ID Consultant or Consultant Microbiologist. Diagnostic tests:
Admit patient medically if P. falciparum suspected or confirmed. Start treatment after laboratory confirmation except in severe disease with strong clinical suspicion. Patients who have taken malaria chemoprophylaxis should not receive the same drug for treatment. Please see HPSC Clinical Guidelines on the Management of Suspected Malaria for further information, available at www.hpsc.ie . Always document travel history for the past 12 months – countries and locations visited, travel dates, prophylaxis taken, prior history of malaria and co-morbidities. Malaria prophylaxis is not 100% effective and having taken prophylaxis does not rule out the possibility of malaria infection. The incubation period may be from 8 days up to 1 year. |
Indication |
Obstetrics - Uncomplicated Malaria in Pregnancy 26-29 |
Likely organisms |
P. falciparum or “species not identified” initially |
Antimalarial Treatment |
1st Trimester of Pregnancy: Quinine Sulphate 600mg TDS PO PLUS Clindamycin 450mg TDS PO for 7 days [If patient cannot tolerate PO due to vomiting, consider IV therapy. Please note Quinine IV is no longer available (Jul 2019). There is limited evidence for the use of artemisinin derivatives in pregnancy: data for > 250 pregnant women in the first trimester did not show evidence of teratogenic risk and data for > 1,500 pregnant women in the second and third trimester did not find an increased risk of miscarriages, stillbirths or malformations. The WHO recommends using artemisinin derivatives as medications of choice for malaria in the second and third trimester. During the first trimester, due to lack of experience, the WHO views artemisinin derivatives as reserve medications that should not be withheld in an individual case where needed. (Reference: Schaeffer C, Peters P, Miller RK. Drugs during pregnancy and lactation, 3rd Edition. UK: Academic Press; 2014). If IV therapy required in the first trimester for uncomplicated malaria, consider Artesunate IV 2.4mg/kg at 0h, 12h, 24h, then daily and switch to PO therapy as above (Quinine/Clindamycin) as soon as the patient can tolerate PO.] 2 nd or 3 rd Trimester of Pregnancy: Artemether-Lumefantrine (Riamet®) PO 20mg/120mg, 4 tablets at 0h, 8h, 24h, 36h, 48h and 60h N.B. Please note the timing of Riamet® doses relates to time from time zero – see worked example below:
N.B. Contact Pharmacy Department prior to discharge to ensure continuity of supply as Riamet® is not readily available in the community. [If patient cannot tolerate PO due to vomiting, start with Artesunate IV 2.4mg/kg at 0h, 12h, 24h, then daily and change to PO Artemether-Lumefantrine (Riamet®) as soon as patient can tolerate PO]. OR Quinine Sulphate 600mg TDS PO PLUS Clindamycin 450mg TDS PO for 7 days If cause of malaria subsequently diagnosed as P. vivax or P. ovale : To prevent relapse, give chloroquine 310mg PO once weekly until delivery. Once baby delivered, contact ID Consultant for advice on how to complete required treatment to prevent relapse. |
Comments |
Malaria is a medical emergency. Always discuss with ID Consultant or Consultant Microbiologist. Diagnostic tests:
Admit patient medically if P. falciparum suspected or confirmed. Start treatment after laboratory confirmation except in severe disease with strong clinical suspicion. Patients who have taken malaria chemoprophylaxis should not receive the same drug for treatment. Please see HPSC Clinical Guidelines on the Management of Suspected Malaria for further information, available at www.hpsc.ie . Always document travel history for the past 12 months – countries and locations visited, travel dates, prophylaxis taken, prior history of malaria and co-morbidities. Malaria prophylaxis is not 100% effective and having taken prophylaxis does not rule out the possibility of malaria infection. The incubation period may be from 8 days up to 1 year. |
Indication |
Obstetrics - Non-falciparum Malaria in Pregnancy 26-29 |
Likely organisms |
P.vivax, P. ovale, P. malariae |
Antimalarial Treatment |
Treatment of malaria caused by P. vivax, P. ovale, P. malariae - chloroquine-sensitive strains : Chloroquine 620mg at 0h, then 310mg at 6hr, 24h and 48h ( N.B . Chloroquine base 620mg = chloroquine phosphate 1,000mg = 4 tablets of Avloclor®) Prevention of relapse if malaria caused by P.vivax or P. ovale : To prevent relapse, give chloroquine 310mg PO once weekly until delivery. Once baby delivered, contact ID Consultant for advice on how to complete required treatment to prevent relapse. Treatment of malaria caused by P. vivax resistant to chloroquine : 1st Trimester of Pregnancy: Quinine Sulphate 600mg TDS PO PLUS Clindamycin 450mg TDS PO for 7 days AND Discuss with ID Consultant regarding further required treatment to prevent relapse. 2 nd or 3 rd Trimester of Pregnancy: Artemether-Lumefantrine (Riamet®) 20mg/120mg, 4 tablets at 0h, 8h, 24h, 36h, 48h and 60h N.B. Please note the timing of Riamet® doses relates to time from time zero – see worked example below:
N.B. Contact Pharmacy Department prior to discharge to ensure continuity of supply as Riamet® is not readily available in the community. AND Discuss with ID Consultant regarding further required treatment to prevent relapse. OR Quinine Sulphate 600mg TDS PO PLUS Clindamycin 450mg TDS PO for 7 days AND Discuss with ID Consultant regarding further required treatment to prevent relapse. |
Comments |
Malaria is a medical emergency. Always discuss with ID Consultant or Consultant Microbiologist. Diagnostic tests:
Admit patient medically if P. falciparum suspected or confirmed. Start treatment after laboratory confirmation except in severe disease with strong clinical suspicion. Patients who have taken malaria chemoprophylaxis should not receive the same drug for treatment. Please see HPSC Clinical Guidelines on the Management of Suspected Malaria for further information, available at www.hpsc.ie . Always document travel history for the past 12 months – countries and locations visited, travel dates, prophylaxis taken, prior history of malaria and co-morbidities. Malaria prophylaxis is not 100% effective and having taken prophylaxis does not rule out the possibility of malaria infection. The incubation period may be from 8 days up to 1 year. |
GBS Antimicrobial Resistance
Benzylpenicillin is the recommended first-line agent for GBS prophylaxis in pregnant patients.
For patients who report penicillin hypersensitivity, ALWAYS check the nature of the reaction to penicillin.
There is limited evidence for the efficacy of alternatives to penicillin to prevent early-onset GBS disease among infants. Cef-AZ-olin (unlicensed in Ireland) and cef-UR-oxime are both cephalosporins that achieve high intra-amniotic concentrations and are recommended as an alternative to penicillin for intrapartum prophylaxis by the CDC and UK Green Top Guidelines, respectively. 14,15 Clindamycin and vancomycin can be used but are not considered reliable alternatives due to very limited evidence. In addition, GBS resistance to clindamycin is increasing both nationally and internationally. Therefore, if the penicillin-allergic patient can tolerate cephalosporins (see penicillin hypersensitivity tile), cef-UR-oxime should be administered in preference to either clindamycin or vancomycin.
References
- Royal College of Obstetricians and Gynaecologists. The Prevention of Early-onset Neonatal Group B Streptococcal Disease. Green-top Guideline No. 36, 3rd Edition, 2017. Available from https://www.rcog.org.uk .
- Verani JR, McGee L and Schrag SJ. Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines from CDC, 2010. Morbidity and Mortality Weekly Report, November 19, 2010 / 59(RR10);1-32. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w
- O’Hanlon M, Ryan D. OLOL GBS resistance data on 52 GBS isolates 2018. On file in OLOL Microbiology Laboratory.
- Knowles SJ, O’Sullivan NP, Meenan AM, et al.Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study. BJOG 2014; DOI: 10.1111/1471-0528.12892.
Other Infections in Pregnancy
Indication |
Obstetrics - Bacterial Tonsillitis 18,21 |
First Line Antimicrobials |
Phenoxymethylpenicillin 666mg QDS PO |
Penicillin Allergy Alternatives |
First trimester: Erythromycin 500mg QDS PO Second and third trimester: Clarithromycin 500mg BD PO |
Comments |
The majority of sore throats are viral; most patients do not benefit from antibiotics. |
Duration |
10 days |
Indication |
Obstetrics - Influenza (Flu) 18,21,30 |
First Line Antimicrobials |
Oseltamivir 75mg BD |
Comments |
|
Duration |
5 days |
Indication |
Obstetrics - Meningitis 18,31 |
First Line Antimicrobials |
Cef-TRI-axone 2g BD IV AND Vancomycin 25mg/kg loading dose (max 2g), followed by 15mg/kg BD IV AND Amoxicillin 2g 4 hourly IV |
Penicillin Allergy Alternatives |
Meropenem 2g TDS IV AND Vancomycin 25mg/kg loading dose (max 2g), followed by 15mg/kg BD IV NB. Use meropenem with great caution and close clinical monitoring if history of immediate-onset or severe penicillin hypersensitivity – approximately 1% risk of immediate-onset hypersensitivity to meropenem in patients with history of immediate-onset penicillin hypersensitivity. 9-12 NB. Contact Consultant Microbiologist for advice and if alternative antimicrobial choice required. |
Comments |
Microbiological Investigations:
|
Duration |
Duration depends on causative organism:
|
Indication |
Obstetrics - Meningococcal Prophylaxis 18,31 Please refer to:
|
Indication |
Obstetrics - Peripheral Vascular Catheter (PVC) Infection |
First Line Antimicrobials |
Flucloxacillin 2g QDS IV
If history of MRSA colonisation, SUBSTITUTE Vancomycin 25mg/kg loading dose (max 2g), followed by 15mg/kg BD IV N.B. Adjust dose if renal impairment, trough level monitoring required, click on link above for calculator and guideline. |
NON-immediate-onset and NON-severe Penicillin Hypersensitivity |
Cef-AZ-olin 2g TDS IV
If history of MRSA colonisation, SUBSTITUTE Vancomycin 25mg/kg loading dose (max 2g), followed by 15mg/kg BD IV N.B. Adjust dose if renal impairment, trough level monitoring required, click on link above for calculator and guideline. |
IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity |
Clindamycin 450mg QDS PO or 600mg QDS IV (excellent oral bioavailability)
If history of MRSA colonisation, SUBSTITUTE Vancomycin 25mg/kg loading dose (max 2g), followed by 15mg/kg BD IV N.B. Adjust dose if renal impairment, trough level monitoring required, click on link above for calculator and guideline. |
Comments |
REMOVE THE INFECTED PVC IMMEDIATELY.
PVCs are a portal of entry for Staph. aureus . PVC infections can manifest as local phlebitis or bloodstream infections. The risk of PVC infection may be reduced by:
Microbiological Investigations:
|
Duration of Treatment |
If blood cultures positive for S. aureus :
If phlebitis with sterile blood cultures:
|
Indication |
Obstetrics - Respiratory Tract Infections – Outpatient Treatment 18,21 |
First Line Antimicrobials |
Amoxicillin 500mg TDS PO |
Penicillin Allergy Alternatives |
1st trimester : Erythromycin 500mg QDS PO 2nd and 3rd trimester : Clarithromycin 500mg BD PO |
Duration |
7 days |
Indication |
Obstetrics - Respiratory Tract Infections – Inpatient Treatment 18,21 |
First Line Antimicrobials |
Co-amoxiclav 1.2g TDS IV AND 1st trimester: Erythromycin 500mg QDS PO 2nd and 3rd trimester: Clarithromycin 500mg BD PO |
Penicillin Allergy Alternatives |
DELAYED-onset Penicillin Hypersensitivity Cef-UR-oxime 1.5g QDS IV AND 1st trimester: Erythromycin 500mg QDS PO 2nd and 3rd trimester: Clarithromycin 500mg BD PO IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Vancomycin 15mg/kg BD IV AND 1st trimester: Erythromycin 500mg QDS PO 2nd and 3rd trimester: Clarithromycin 500mg BD PO |
Comments |
|
Duration |
7 – 10 days |
Indication |
Obstetrics - Varicella Zoster Virus (VZV) – Post Exposure Prophylaxis during Pregnancy |
First Line Prophylaxis |
Indication |
Obstetrics - Vulvovaginal Candidiasis – Uncomplicated 8,18,21, 32 |
First Line Antimicrobials |
Clotrimazole 200mg vaginal pessary at night for 6 nights Clotrimazole cream may also be used topically 2 to 3 times daily |
Comments |
Please discuss with Consultant Microbiologist if patient has PPROM. |
Useful References on Medicines in Pregnancy and Breast-Feeding
NB. The prescriber should always check the safety of each antimicrobial for use in pregnant or breast-feeding patients.
Information on the Safety of Antimicrobials in Pregnancy
- Medication Guidelines for Obstetrics and Gynaecology First Edition Volume 2: Antimicrobial safety In Pregnancy and Lactation (2016)
- British National Formulary (free access on hospital computers)
- Summary of Product Characteristics
- Drugs in Pregnancy and Lactation (Briggs GG et al, 2017) (free access on hospital computers)
- United Kingdom Teratology Information Service
- Toxbase® Database (username and password required)
- Contact the Pharmacy Department for further information.
Information on the Safety of Antimicrobials in Breast-Feeding
- Medication Guidelines for Obstetrics and Gynaecology First Edition Volume 2: Antimicrobial safety In Pregnancy and Lactation (2016)
- British National Formulary (free access on hospital computers)
- Summary of Product Characteristics
- US National Library of Medicine: LactMed Database
- United Kingdom Medicines Information Monographs on Drugs in Lactation
- Contact the Pharmacy Department for further information.
Pelvic Inflammatory Disease
Indication |
Pelvic Inflammatory Disease - Mild to Moderate – Outpatient Treatment 16,19,35,37 |
First Line Antimicrobials |
Not pregnant or breastfeeding: Doxycycline 100mg BD PO for 14 days AND Metronidazole 400mg BD PO for 14 days AND If N. gonorrhoeae strongly suspected, ADD Cef-TRI-axone 1g IM stat
IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Contact GU/ID Consultant for advice. |
Comments |
NB. Refer the patient and partner to the GUM clinic: 086 8241847. |
Indication |
Pelvic Inflammatory Disease - Severe – Inpatient Treatment 16,19,35,37 |
First Line Antimicrobials |
Not pregnant or breastfeeding: Cef-TRI-axone 2g daily IV AND Doxycycline 100mg BD PO (if cannot tolerate PO, Erythromycin 500mg QDS IV) AND Metronidazole 500mg BD IV
Oral switch: Doxycycline 100mg BD PO and Metronidazole 400mg BD PO to complete 14 days total
IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Contact ID Consultant for advice.
Pregnant or Lactating Patient: Cef-TRI-axone 2g daily IV AND Erythromycin 500mg QDS PO (if cannot tolerate PO, Erythromycin 500mg QDS IV) AND Metronidazole 500mg BD IV
Oral switch: Erythromycin 500mg QDS PO and Metronidazole 400mg BD PO to complete 14 days total
IMMEDIATE-onset or SEVERE Penicillin Hypersensitivity Contact ID Consultant for advice. |
Comments |
NB. Refer the patient and partner to the GUM clinic: 086 8241847. |
References
- RCPI Hospital Antimicrobial Stewardship Working Group 2012. Start Smart then Focus Antibiotic Care Bundle. Available from www.rcpi.ie .
- U.S. Food and Drug Administration (FDA). Rule: Content and Format of Labeling for Human Prescription Drug and Biological Products; Requirements for Pregnancy and Lactation Labeling. Dec 2014. Available from https://www.federalregister.gov/articles/2014/12/04/2014-28241/content-and-format-of-labeling-for-human-prescription-drug-and-biological-products-requirements-for , accessed 27/02/15.
- Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation, 9 th Edition. Philadelphia: Lippincott Williams and Wilkins; 2011.
- Beaumont Hospital Antimicrobial Guidelines 2018. Obtained with permission from Consultant Microbiologist, Beaumont Hospital, 2018.
- Irish Medication Safety Network. Briefing Document: Reducing preventable harm to patients with known drug allergies, 2012. Available from www.imsn.ie .
- Thong B and Vervloet D. Drug Allergies, 2014. World Allergy Organisation. Available from www.worldallergy.org .
- NICE Guideline CG183. Drug allergy: diagnosis and management of drug allergy in adults, children and young people. 2014. Available from www.nice.org.uk .
- BMJ Group and Pharamceutical Press. British National Formulary online. Available from www.medicinescomplete.com , accessed 27/02/15.
- McKenna C. Medicines Information Enquiry on cross-reactivity of penicillin and meropenem, Mar 2014. On file in OLOL Pharmacy.
- Frumin J, Gallagher JC. Allergic cross-sensitivity between penicillin, carbapenem, and monobactam antibiotics: what are the chances? Ann Pharmacother 2009;43:304-15.
- Cunha BA , Hamid NS, Krol V et al. Safety of meropenem in patients reporting penicillin allergy: lack of allergic cross reactions J Chemother. 2008;20(2):233-7.
- Romano A, Viola M, Gueant-Rodriquez RM et al. Brief communication: tolerability of meropenem in patients with IgE-mediated hypersensitivity to penicillins. Ann Intern Med 2007;146(4):266-9.
- Romano A, Gaeta F, Valluzzi RL et al. Absence of cross-reactivity to carbapenems in patients with delayed hypersensitivity to penicillins. Allergy 2013;68(12):1618-21.
- Royal College of Obstetricians and Gynaecologists. The Prevention of Early-onset Neonatal Group B Streptococcal Disease. Green-top Guideline No. 36, 3rd Edition, 2017. Available from https://www.rcog.org.uk .
- Verani JR, McGee L and Schrag SJ. Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines from CDC, 2010. Morbidity and Mortality Weekly Report, November 19, 2010 / 59(RR10);1-32. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w
- O’Hanlon M, Ryan D. OLOL GBS resistance data on 52 GBS isolates 2018. On file in OLOL Microbiology Laboratory.
- Knowles SJ, O’Sullivan NP, Meenan AM, et al. Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study. BJOG 2014; DOI: 10.1111/1471-0528.12892.
- McGuire M, Drew R, Turner R. Medication Guidelines for Obstetrics and Gynaecology, Antimicrobial Prescribing Guideline. Jan 2017, 1 st Edition, Vol 1. Available from www.hse.ie .
- National Clinical Effectiveness Committee. Sepsis Management for Adults (including maternity). National Clinical Guideline No. 26. 2021. Available from www.gov.ie/en/collection/c9fa9a-national-clinical-guidelines/
- Rotunda Hospital Antimicrobial Guidelines. 2018. Obtained with permission from Consultant Microbiologist, Rotunda Hospital, 2018.
- Royal College of Obstetricians and Gynaecologists. Bacterial Sepsis in Pregnancy. Green-top Guideline No. 64a, 1 st Edition, 2012. Available from https://www.rcog.org.uk .
- Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and Directorate of Strategy and Clinical Care, Health Service Executive. Preterm Prelabour Rupture of Membranes (PPROM). Guideline No. 24, Version No. 1. 2013. Available from http://www.rcpi.ie/content/docs/000001/781_5_media.pdf
- O’Hanlon M. Our Lady of Lourdes Hospital Antimicrobial Resistance Data for E. coli in urine samples of maternity patients, 2017. On file in OLOL Microbiology Department.
- Nordeng H, Lupattelli A, Romoren M, et al. Neonatal outcomes after gestational exposure to nitrofurantoin. Obstet Gynecol 2013;121:306-13.
- HPSC and Beaumont Hospital. Clinical Guidelines on the Management of Suspected Malaria. 2017. Available from www.hpsc.ie .
- Royal College of Obstetricians and Gynaecologists. Green-Top Guideline No. 54B. The diagnosis and treatment of malaria in pregnancy, 2010. Available from www.rcog.org.uk .
- Laloo DG, Shingadia D, Bell DJ et al, on behalf of the PHE Advisory Committee on Malaria Prevention in UK Travellers. UK Malaria Treatment Guidelines 2016. Journal of Infection 2016;72:635e649.
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