Department of Obstetrics and Gynaecology
The current recommended empiric antibiotic choices and empiric durations for suspected bacterial infections at CHBAH, based on consensus agreement between Infectious Diseases (ID), Microbiology and specialties after review of our 2018 antibiogram data, is as follows until directed therapy is possible.
Gynaecology
Community Acquired non-CNS Infections (first 48 hours of admission):
- GFR>30*: Co-amoxiclav 1.2g IV 8 hourly, max 5 days + stat dose IV Gentamicin
- GFR<30*: Co-amoxiclav 600mg IV 8 hourly, max 5 days + stat dose IV Gentamicin
*For Pelvic Inflammatory Disease (PID): Add Azithromycin 2g po stat
Health-care Associated Infections (after 48 hours of admission or readmission within 2 weeks):
- GFR>50**: Piptaz 4.5g IV 6 hourly (max 5 days) + Amikacin 15mg/kg/day (max 3 days) THESE DRUGS ONLY
- GFR<50**: Ertapenem* 1g IV stat (loading dose) followed by renally adjusted doses (max 5 days) THESE DRUGS ONLY
**Does not include patients without source control. All patients must be discussed with the O&G consultant before choosing empiric antibiotics, to consult Infectious Diseases if not improving
Obstetrics/ Post-natal
Postnatal Community Acquired non-CNS Infections (first 48 hours of admission)
NB Puerperal sepsis:
- GFR>30: Co-amoxiclav 1.2g IV 8 hourly, max 5 days (+ stat dose IV Gentamicin* if uterine source)
- GFR<30: Co-amoxiclav 600mg IV 8 hourly, max 5 days (+ stat dose IV Gentamicin* if uterine source)
*Continuation of Gentamicin may be required if patient admitted to High Care, or has severe sepsis (qSOFA score >2; Quick Sepsis-related Organ Assessment (qSOFA))
Obstetric Community Acquired non-CNS Infections (first 48 hours of admission):
Non-uterine infections
- Ceftriaxone 1g IV daily, max 5 days
Uterine infections (Chorioamnionitis)
- Ampicillin 1g IV 6 hourly + Metronidazole 400mg po 8 hourly + Gentamicin 240mg IV daily, max 7 days
Postnatal and Obstetric Community Acquired CNS Infections (first 48 hours of admission):
- Ceftriaxone 2g IV 12 hourly, max 10 days (stop if LP/ CTB not suggestive)
- If listeria is suspected, add Ampicillin 3g IV 6 hourly and consult Infectious Diseases
Obstetric Health-care Associated Infections (after 48 hours of admission or readmission within 2 weeks):
- GFR>40: Piptaz 4.5g IV 6 hourly (max 5 days)
- GFR<40: Piptaz 2.25g IV 6 hourly (max 5 days)
Pre-operative surgical antibiotic prophylaxis
Only 1 dose of cefazolin should ideally be given to patients 30-60 minutes prior to elective caesarean section surgical incision. A second dose may be given if the surgery lasts >3 hours or blood loss exceeds 1000ml1
1. Antibiotic Surgical Prophylaxis Guideline. Gauteng Provincial Antimicrobial Stewardship Committee. November 2017
2. Jocum J. Surgical antibiotic prophylaxis: Are you doing it right? South Afr J Anaesth Analg 2018; 24(3)(Supplement 1): S49-53.