Antibiotics in Pregnancy

Question 1

uncomplicated UTI or asymptomatic bacturaemia

Answer 1

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.

Question 2

how do you manage pregnant women with recurrent UTIs or recurrent symptomatic bacturaemia

Answer 2

If 2 or more positive MSUs then test 3-4 w eekly and treat each positive sample as usual

Question 3

chlamydia

Answer 3

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

Question 4

thrush

Answer 4

Clotrimazole 500mg pessary stat + clotrimazole 1% cream 2-3 times daily.

Question 5

BV

Answer 5

Metronidazole 400mg bd for 5-7 days.

Question 6

genital herpes

Answer 6

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.

Question 7

maternal sepsis empirical IV antibiotics in pregnancy/postpartum

Answer 7

IV co-amoxiclav 1.2g tds (clinda if pen allergy)
+/- IV gentamicin depending on
severity

IVOST to co-amox alone
safe in breastfeeding

Question 8

maternal septic shock in pregnancy/post partum

Answer 8

IV piperacillin/tazobactam 4.5g
qds + IV clindamycin 1.2g qds +
IV gentamicin

IVOST to coamox alone
safe in breastfeeding

Question 9

preterm prom antibiotics

Answer 9

erythromycin up to 10 days/until labour established

Question 10

endometritis in post natal woman

Answer 10

co amoxiclav - if tender/sepsis refer to hospital

cotrimox and met if pen allergy

Question 11

post cs wound infection

Answer 11

Flucloxacillin 1g qds + metronidazole 400mg tds OR clindamycin (dose as per cellulitis guidance)
for 7 days then review .

Question 12

3rd or 4th degree tear

Answer 12

Refer to Obs/Gynae surgical prophylaxis guideline for pre-procedure one off IV antibiotics followed by oral co-amoxiclav 625mg tds for 7 days

Question 13

perineal infection

Answer 13

co amox and refer

Question 14

mastitis

Answer 14

conservtive treatment with NSAID and warm compress

if severe no improving in 12-24 hours /infection/fever - fluclox or clinda

Question 15

breast abscess

Answer 15

Send pus for culture. Flucloxacillin 1g qds or clindamycin (dosing as per cellulitis guidance) if penicillin
allergy for 7-10 days

Question 16

thrush in breast feeding

Answer 16

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)

Question 17

nipple fissure

Answer 17

only treat if infection

if localised - topical fusidic acid
if widespread - oral fluclox

Question 18

what do you need to be careful of with cotrimoxazole

Answer 18

if breastfeeding monitor baby for hyperbilirubinaemia and kernicterus. If baby premature or already jaundiced, avoid and use
ciprofloxacin 500mg bd + clindamycin 450mg tds