Chorioamnionitis
Pregnancy
- 1st trimester (see PID)
- 2nd/3rd trimester
- Hospitalization should be considered for all pregnant patients with suspect PID/chorioamnionitis.
- Evacuation of uterus may be required for cure. Refer patient to specialist obstetrician.
- If chlamydia or gonorrhea suspected/documented, refer to these sections for management.
- If preterm labour with intact membranes and delivery imminent, give Group B Streptococcus (GBS) prophylaxis (see Intrapartum Antimicrobial Prophylaxis of GBS).
- If premature rupture of membranes (PROM) and < 37 weeks and pregnancy to continue, give prophylactic erythromycin and amoxicillin (see Antimicrobial Prophylaxis for PROM).
S. agalactiae (Group B Streptococcus)
S. pyogenes (Group A Streptococcus)
S. pneumoniae
Ureaplasma urealyticum
Gardnerella vaginalis
Mycoplasma hominis
Listeria monocytogenes
Lactobacillus spp
Haemophilus spp
Enterobacterales spp
Anaerobes
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ampicillin | 2g IV q6h | Until evacuation/delivery of fetus |
| + | ||
| Gentamicin |
5mg/kg IV q24h or 1.5mg/kg IV q8h |
|
| + if Caesarean delivery: | ||
| Metronidazole | 500mg IV q12h | Stat at Caesarean delivery then q12h until delivery of fetus |
| Metronidazole allergy/intolerance | ||
| Clindamycin | 900mg IV q8h | Stat at Caesarean delivery then q8h until delivery of fetus |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Cefazolin | 2g IV q8h | Until evacuation/delivery of fetus |
| + | ||
| Gentamicin |
5mg/kg IV q24h or 1.5mg/kg IV q8h |
|
| + if Caesarean delivery: | ||
| Metronidazole | 500mg IV q12h | Stat at Caesarean delivery then q12h until delivery of fetus |
| Metronidazole allergy/intolerance | ||
| Clindamycin | 900mg IV q8h | Stat at Caesarean delivery then q8h until delivery of fetus |
| or | ||
| [Clindamycin | 900mg IV q8h | Until evacuation/delivery of fetus |
+ |
||
| Gentamicin] |
5mg/kg IV q24h or 1.5mg/kg IV q8h |
|