Flashcards in Antibiotics in Pregnancy Deck (18)
uncomplicated UTI or asymptomatic bacturaemia
1st or 2nd trimester nitrofurantoin MR 100mg bd or 50mg qds.
3rd trimester trimethoprim 200mg bd (unlicensed). 2nd line (any trimester) cefalexin 500mg tds or as per sensitivities.
Treat for 7 days and sample for test of cure.
how do you manage pregnant women with recurrent UTIs or recurrent symptomatic bacturaemia
If 2 or more positive MSUs then test 3-4 w eekly and treat each positive sample as usual
Azithromycin 1g stat (unlicensed) or erythromycin 500mg qds (7 days)
plus test of cure at least 3 weeks after end of treatment. Rescreen in 3rd trimester
Clotrimazole 500mg pessary stat + clotrimazole 1% cream 2-3 times daily.
Metronidazole 400mg bd for 5-7 days.
FIRST EPISODE EVER IN 3RD TRIMESTER –URGENT REFERRAL TO SEXUAL HEALTH & INFORM OBSTETRICS
MULTIPLE RECURRENCES IN PREGNANCY, OR FIRST EPISODE EVER IN 1ST/2ND T RIMESTE R– ROUTINE REFERRAL TO SEXUAL
HEALTH AND INFORM OBSTETRICS
Aciclovir 400mg tds for 5 days.
maternal sepsis empirical IV antibiotics in pregnancy/postpartum
IV co-amoxiclav 1.2g tds (clinda if pen allergy)
+/- IV gentamicin depending on
IVOST to co-amox alone
safe in breastfeeding
maternal septic shock in pregnancy/post partum
IV piperacillin/tazobactam 4.5g
qds + IV clindamycin 1.2g qds +
IVOST to coamox alone
safe in breastfeeding
preterm prom antibiotics
erythromycin up to 10 days/until labour established
endometritis in post natal woman
co amoxiclav - if tender/sepsis refer to hospital
cotrimox and met if pen allergy
post cs wound infection
Flucloxacillin 1g qds + metronidazole 400mg tds OR clindamycin (dose as per cellulitis guidance)
for 7 days then review .
3rd or 4th degree tear
Refer to Obs/Gynae surgical prophylaxis guideline for pre-procedure one off IV antibiotics followed by oral co-amoxiclav 625mg tds for 7 days
co amox and refer
conservtive treatment with NSAID and warm compress
if severe no improving in 12-24 hours /infection/fever - fluclox or clinda
Send pus for culture. Flucloxacillin 1g qds or clindamycin (dosing as per cellulitis guidance) if penicillin
allergy for 7-10 days
thrush in breast feeding
FOR MOTHER:Miconazole 2% cream (do not use oral gel on mother) applied to nipple and areola after
each feed for 7 days. If pain is severe or deep within
the breasts after feeds systemic treatment may be needed with fluconazole 300mg on day one follow ed by
150mg daily for at least 10 days (unlicensed treatment). Review diagnosis if no improvement after 10
days and refer for further breastfeeding assessment. Caution is required if baby <6 weeks old.
FOR INFANT: Miconazole oral gel Unlicensed in < 4 months. Apply gently to oral mucosa to avoid choking:
Smear carefully around the inside of the mouth for at least 7 days after lesions have healed. Nystatin oral suspension 1ml qdsafter feeds for 48h after symptoms have cleared (unlicensed in neonates)
only treat if infection
if localised - topical fusidic acid
if widespread - oral fluclox