Obstetrics / Gynaecological Infections

Indication Antibiotic Recommended

First Line Alternative
Endometritis/ Piperacillin/Tazobactam 4.5g IV q8h Imipenem/Meropenem
septic pelvic phlebitis
(post partum)
Also inform neonatal team if mother has endometritis
PID / salpingitis / tubo- Ceftriaxone + Metronidazole + Amox / Clav + Doxycycline
ovarian abscess Doxycycline
Septic abortion Piperacillin/Tazobactam + Doxycycline Imipenem + Doxycycline
Candida vaginitis Clotrimazole vaginal pessaries Fluconazole 150mg single dose

Gynecological and Obstetrics Surgery

Indications First line Alternate
Vaginal / abdominal / radical / Cefazolin <120 kg: 2g IV Clindamycin 900mg IV
laparoscopic hysterectomy >120 kg: 3g IV +Gentamicin 5mg/kg IV
(single dose) (Single dose)

PPROM Ampicillin 2g q6h IV+ Erythromycin alone in penicillin

Erythromycin 250 mg PO q6h for allergic patients
48 hours then Amoxicillin 250 mg
PO q8h + Erythromycin 250 mg
PO q8h for 5 days.
OR
Ampicillin 2g iv q6h for 48 hours
+Azithromycin 1g IV once then
Amoxicillin 250mg q8h for 5
days
Caesarian section (high risk only) Cefazolin <120 kg: 2g IV Clindamycin 900mg + Gentamicin
>120 kg: 3g IV 5mg/kg IV
(single dose) (single dose)

Uterine evacuation (suction Doxycycline 200 mg pre and Metronidazole 400 mg pre and post
D&C/D&E) post procedure procedure
(For patients with N.gonorrhea and
C.trachomatis, treat STD with
minimal delay in uterine
evacuation)

Penicillin allergic: Patients not at

high risk for anaphylaxis Cefazolin
2gm IV then 1g q8h until delivery.

Patients at high risk for anaphylaxis

from beta-lactams: Clindamycin
900 mg IV q8h until delivery OR
Vancomycin 1g IV q12h until
delivery
GBS Benzyl penicillin 5mu IV after the
onset of labor and 2.5 – 3 mu IV
q4h until delivery
OR
Ampicillin 2gm IV then 1gm IV
q4h till delivery
Hysterosalpingography Doxycycline 200 mg pre- Clindamycin 900 IV +
procedure Amikacin 15 mg /kg
Cystocele and rectocele repair None -
Colporrhaphy/Vaginal sling Cefazolin <120 kg: 2g IV
>120 kg: 3g IV
Tubal ligation / Cystoscopy / None(If UTI identified treat
endometrial biopsy / hysteroscopy / appropriately)
IUD insertion / laproscopic and
cervical tissue excision procedures /
urodynamics