Post-partum infection and/or Suspected endometritis

Suspected endometritis and/or postpartum infection

Includes:

• Endometritis, suspected, post partum   
• Retained placenta and evidence of infection 
• Post partum haemorrhage and fever
• Wound infection, post partum: typically surgical site infection (post LSCS) or Perineal infection (including post instrumental delivery and episiotomy)

Review antibiotics daily, treat 3-5 days

Preferred: includes penicillin allergy non-severe:

 cefazolin 2g tds iv + metronidazole 400mg tds po (or 500mg tds iv if oral not possible)

Alternative: for severe penicillin allergy: gentamicin 5mg/kg/ daily for up to 3 days (check levels at 6-14 hours post dose to determine dosing interval, see here, + clindamycin 600mg tds iv

MRSA positive: add teicoplanin 12mg/kg 12 hourly for 3 doses, then 24 hourly to above antibiotics

·        Preferred, including for mild penicillin allergy: cefalexin 1g tds po +/-  metronidazole 400mg tds po

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

For MRSA positive patients: co-trimoxazole 960mg po bd

• For breastfeeding patients: Avoid co-trimoxazole in known G6PD deficiency, hyperbilirubinaemia and in jaundiced infants because of risk of kernicterus. In these situations discuss with Micro/ID.

Typically 3 days treatment

Preferred: (including non-severe penicillin allergy)  cefalexin 1g tds po (including mild penicillin allergy) + metronidazole 400mg tds po

Alternative: (including for severe penicillin allergy or if MRSA positive)  co-trimoxazole 960mg bd po

• For breastfeeding patients: Avoid co-trimoxazole in known G6PD deficiency, hyperbilirubinaemia and in jaundiced infants because of risk of kernicterus. In these situations discuss with Micro/ID.