OB/GYN antibiotics

Mastitis

• No need to routinely interrupt breastfeeding with puerperal mastitis.
• For mild symptoms <24 hours, supportive care may be sufficient
  • Effective milk removal (frequent breast feeding - use pumping to augment milk removal)
  • Analgesia (NSAIDs)

Treatment directed at S. aureus and Strep and E. coli

• Uncomplicated mastitis → 10 days of antibiotics (regardless of MRSA suspicion)
• Dicloxacillin 500mg PO q6hrs OR
• Cephalexin 500mg PO q6hrs OR
  • Add TMP/SMX 2DS tabs PO q12hrs if suspect MRSA
• Clindamycin 450mg PO q8hrs OR
• Amoxicillin/Clavulanate 875mg PO q12hrs OR
• Azithromycin 500mg PO x1 day 1, then 250mg PO daily days 2-5

Endometritis

<48hrs Post Partum

Treatment is targeted against polymicrobial infections, most often 2-3 organisms of normal vaginal flora

• (Preferred first line) Clindamycin 900mg IV q8hrs PLUS Gentamicin 5mg/kg IV q24hrs or 1.5mg/kg IV q8hrs OR
• Doxycycline 100mg IV/PO q12hrs PLUS
  • Ampicillin/Sulbactam 3g IV q6hrs
  • Cefoxitin 2g IV q6hrs

>48hrs Post Partum

• Doxycycline 100mg IV or PO q12hrs + Metronidazole 500mg IV or PO q8hrs
  • Use Metronidazole with caution in breastfeeding mothers as its active metabolite is present in breast milk at concentrations similar to maternal plasma concentrations

PID

Antibiotics

• No sexual activity for 2 weeks;
• Treat all partners who had sex with patient during previous 60 days prior to symptom onset

Outpatient Antibiotic Options

• Ceftriaxone 500mg IM x1 (1g if >150kg) + Doxycycline 100mg PO BID x 14 days + Metronidazole 500mg PO BID x 14 days
• Cefoxitin 2g IM x1 plus Probenecid 1g PO + Doxycycline 100mg PO BID x 14 days + metronidazole

Inpatient Antibiotic Options

• Recommended: Ceftriaxone 1g IV q24hr OR Cefoxitin 2g IV q6hr OR Cefotetan 2g IV q12hr + Doxycycline 100mg PO or IV q12hr + Metronidazole 500mg IV or PO q12hr OR
• Clindamycin 900mg IV q8hr + Gentamicin 2mg/kg loading then 1.5mg/kg q8hr IV OR
• Ampicillin/Sulbactam 3g IV q6hr + doxycycline 100mg IV/PO q12hr
• Azithromycin 500mg IV q24h x1-2 days, then 250mg PO q24h x5-6 days

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)