OB/GYN antibiotics

Bacterial Vaginosis

First Line Therapy

• Metronidazole 500 mg PO Twice Daily for 7 days OR
• Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, Daily for 5 days OR
• Clindamycin cream 2%, one full applicator (5 g) intravaginally Nightly for 7 days

Metronidazole does not cause a disulfiram-like reaction with alcohol.

Alternative Regimin

• Clindamycin 300 mg PO BID for 7 days OR
• Clindamycin ovules 100 mg intravaginally qHS for 3 days (do not use if patient has used latex condom in last 72 hours)

Other regimens have been studied and have varying efficacy compared to placebo but due to cost and availability do not represent alternatives outside of absolute contraindications to preferred regimens.

Pregnant

• Metronidazole 500mg PO Twice a day x 7 days
• Metronidazole 250mg PO Three times a day has also been studied
• Although metronidazole crosses the placenta, no evidence of teratogenicity or mutagenic effects among infants has been reported in multiple cross-sectional, case-control, and cohort studies of pregnant women

Prophylaxis (Sexual Assault)

• Metronidazole 500mg PO Twice a day x 7 days

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

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

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)

External links

• Drugs and Lactation Database (LactMed), National Institutes of Health, US National Library of Medicine