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Chapter 183. Antibiotic Prophylaxis and Therapy in Obstetrics

Imre Rédai, MD, FRCA

Antibiotic therapy is guided by local pathogens. Consult your infectious diseases specialist for information and advice for best prophylactic and empirical therapy. Infected patients should get appropriate cultures sent and pathogen sensitivities determined to guide therapy.

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General Guidelines
ProcedureProphylaxisComments
Uncomplicated vaginal deliveryNo antibiotic
Cesarean section
  • Cefazolin 2 g before incision
    • Delaying prophylactic antibiotics until after delivery is no longer recommended
  • In patients with ruptured amniotic membranes, cefoxitin 2 g may be considered
  • If penicillin allergy
    • Clindamycin 600 mg
Antibiotic prophylaxis for patients at risk for bacterial endocarditisNot indicated for routine vaginal deliveries and routine Cesarean sections
  • Select patients where antibiotic prophylaxis should be considered
    • Chorioamnionitis
    • Concomitant urinary tract infection
    • High-risk patients (prosthetic heart valves or conduits, unrepaired cyanotic lesions)
Group B streptococcus carriers (GBS + patients)Penicillin 5 million U loading dose followed by 2.5 million U q4 h until delivery
  • If penicillin allergy, depending on culture and sensitivity
    • Erythromycin 500 mg q8 h
    • Clindamycin 600 mg q6 h
Chorioamnionitis
  • Empirical therapy options
    • Ampicillin 2 g q6 h + gentamicin 1.5 mg/kg q8 h
    • Cefoxitin 2 g q6 h
    • Ampicillin/sulbactam 3 g q6 h
  • Continue antibiotics for at least 24 h postpartum
  • ±Anaerobic coverage as well
    • Metronidazole 500 mg q8 h, or
    • Clindamycin 600 mg q8 h
  • If penicillin allergy
    • Vancomycin 1 g q12 h + gentamicin 1.5 mg/kg q8 h ± anaerobic coverage
Acute pyelonephritis
  • Ampicillin 2 g q6 h and gentamicin 1.5 mg/kg q8 h
  • Ceftriaxone 1 g q24 h
Avoid fluoroquinolones in pregnancy
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1. American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 120: use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2011 Jun;117(6):1472–1483.   [PubMed: 21606770]
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2. American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee opinion no. 421, November 2008: antibiotic prophylaxis for infective endocarditis. Obstet Gynecol. 2008 Nov;112(5): 1193–1194.   [PubMed: 18978128]

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