Drug Therapy During Labor and Delivery, Part 1

Gerald G. Briggs; Stephanie R. Wan


Am J Health Syst Pharm. 2006;63(11):1038-1047. 

In This Article

Prevention of Bacterial Endocarditis

Bacterial endocarditis is relatively uncommon; it most often occurs postoperatively in patients with pre-existing cardiac abnormalities. Bacteremia occurring during parturition is also uncommon, reported in about 1-5% of patients undergoing vaginal or cesarean delivery.[27,28] The decision to administer intrapartum prophylactic antibiotics for prevention of bacterial endocarditis is made based on stratification of individual patient risk factors, as defined by the American College of Cardiology and the American Heart Association (box). Antibiotic prophylaxis is recommended for patients in the high- and moderate-risk categories only in the presence of suspected bacteremia or active intraamniotic infection. Antibiotic prophylaxis is considered optional for high-risk patients who will be undergoing an uncomplicated vaginal delivery. Regardless of the mode of delivery, intrapartum prophylaxis for bacterial endocarditis is not recommended for patients in the negligible-risk category. Antibiotic prophylaxis is also not recommended in the moderate-risk category for patients undergoing an uncomplicated delivery.[29]

When antibiotic prophylaxis is recommended in high-risk patients, the preferred regimen is ampicillin 2 g i.v. or i.m. plus gentamicin 1.5 mg/kg (maximum 120 mg) i.v. administered within 30 minutes before delivery, followed by ampicillin 1 g i.v. or i.m. (or amoxicillin 1 g [as the trihydrate] orally) six hours later. If antibiotic prophylaxis is recommended in moderate-risk patients, the preferred regimen is the same, except that the gentamicin and second dose of ampicillin or amoxicillin may be eliminated.[29,30] In the event of a penicillin allergy, vancomycin 1 g i.v. is recommended instead of ampicillin.


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