Which antibiotics are used for treatment of chorioamnionitis?

Updated: May 08, 2018
  • Author: Fayez M Bany-Mohammed, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

Clindamycin may be used to treat S aureus and anaerobes. Gentamicin provides broad-spectrum coverage against gram-negative bacteria. These antibiotics should be given intravenously. The drugs mentioned above are generally safe for the mother and fetus. An absolute contraindication to using these antibiotics is a known allergic reaction to them. Renal function must always be considered when using antibiotics, especially aminoglycosides. With acute chorioamnionitis, these antibiotics should be used only during the intrapartum period when the mother is febrile. No additional doses are required after vaginal delivery; however, one additional dose of the chosen regimen is indicated following cesarean delivery. [30] The addition of anaerobic coverage after cesarean delivery may be considered (clindamycin or metronidazole) to decrease the risk of endometritis. Alternative regimens for acute chorioamnionitis include monotherapy with ampicillin–sulbactam, piperacillin–tazobactam, cefotetan, cefoxitin, or ertapenem.

If a urinary tract infection is present, the appropriate antibiotic or combination of antibiotics should be used to treat the specific bacterium isolated from the urine.

Erythromycin is infrequently used in women allergic to penicillin. It is not recommended for GBS prophylaxis because significant numbers of GBS strains are erythromycin resistant. Its ability to enter urogenital secretions has been questioned, especially in the treatment of U urealyticum-related or Mycoplasma hominis-related colonization in pregnant women. Of the invasive GBS strains that were isolated in one study, resistance to either clindamycin or erythromycin was in excess of 20%, whereas colonizing isolates of GBS had resistance in more than 40% of cases. [230] A report from the Centers of Disease Control and Prevention (CDC) noted that, of 4882 GBS isolates, 15% and 32% were resistant to clindamycin and erythromycin, respectively. [231] The GBS resistance to erythromycin and clindamycin is global in nature, with several studies reporting this problem from different parts of the world, including China, [232] Brazil, [233] Spain, [234] and Italy, [235] among others. These reports suggest that erythromycin or clindamycin used as chemoprophylaxis to prevent GBS infection in neonates is problematic in women with penicillin allergy. Per CDC guidelines, [170] clindamycin may be used intrapartum only when the isolated GBS is documented to be susceptible to clindamycin; otherwise, vancomycin would be the drug of choice.


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