Ante-natal infection (chorioamnionitis, PROM with signs of infection, suspected infection in labour)

Ante-natal or post-partum - severe sepsis / septic shock

Stable patient with fever and suspected chorioamnionitis (NOT severe sepsis):

• ·         Fever in labour
• ·         Odorous liquor
• ·         Tachycardia

Preferred: (including non-severe penicillin allergy) cefazolin 2g tds iv +metronidazole 400mg tds po

Alternative: (MRSA positive or severe penicillin allergy) teicoplanin 12mg/kg 12 hourly for 3 doses, then 24 hourly + clindamycin 600mg tds iv

Deteriorating patient already on cefazolin, teicoplanin or benzyl penicillin:

• add gentamicin 5mg/kg/ daily for up to 3 days (check levels at 6-14 hours post dose to determine dosing interval, see here
• consider clindamycin 600mg tds iv/po (stop metronidazole, if clindamycin commenced)

Oral options/  IV to oral switch

Preferred: including for non-severe penicillin allergy:  cefalexin 1g tds po

·         Alternative: including for severe penicillin allergy: clindamycin 450mg tds po 

      Discuss MRSA positive cases with Micro/ID