Antibiotics and Common Infections Revision

2020/
2021
Antibiotic use in obstetrics and

gynecology
By emrcog online sessions
Based on different guidelines, tog
articles and BASHH guidelines
Ahmed
Grizli777
2020/2021
eMRCOG final revision ( Common infections & antibiotics )
Urinary tract infections
Q- What is the most common causative organism ?
Ecoli Gram negative rods accounts for >50%
Specimens of urine provided by postpartum women are frequently

contaminated with lochia and the normal flora of the perineum and
genitalia so cautious interpretation is required.
• The presence of leukocytes, protein and blood in a mid-

stream sample of urine is suggestive of current infection and
a specimen should be sent for bacterial culture.
• Significant bacteriuria is taken as >100,000 CFU/ml and an

abnormal white cell count is >10 per mm3.
• Treatment
• First-line treatment will include analgesia and rehydration.
Oral rehydration is sufficient if tolerated but intravenous
fluids may be necessary.
What are the Consideration of Drug safety during

breast feeding ?
Most cases will respond to penicillins or
cephalosporins.
Sulphonamides and nitrofurantion are best avoided
in breastfeeding mothers but trimethoprim is
considered safe.
WWW.emrcog.com WhatsApp : +447376394692

Q- what is the role of Gentamicin ?
• Gentamicin is useful for recurrent and unusual cases. In these

instances, underlying renal function must be checked and treatment
monitored with gentamicin levels.
• Oral therapy may be sufficient but for women that are very ill,
hospital admission with intravenous therapy will be required. Acute
pyelonephritis should be treated aggressively.
Pyelonephritis key points ( in both pregnant and postoperative )

updated from NICE guideline 2019
Acute pyelonephritis is an infection of one or both kidneys usually

caused by bacteria travelling up from the bladder – the most
common causative pathogen is Escherichia coli.
• Complications of acute pyelonephritis include:

o Sepsis.
o Parenchyma renal scarring.
o Recurrent urinary tract infections.
o Renal abscess formation.
o Preterm labour in pregnancy.
o Emphysematous pyelonephritis.
• Acute pyelonephritis should be suspected in people with signs

or symptoms of a urinary tract infection (for example, dysuria,
frequency, urgency) accompanied by any new signs or symptoms of
pyelonephritis (including fever, nausea, vomiting, or flank pain).

• A midstream or catheter specimen of urine should be sent for culture

and sensitivity.
o A urine dipstick test is not necessary, but may be a useful
adjunct to guide diagnosis..
• A final diagnosis of acute pyelonephritis should be made in people

with :
loin pain and/or fever if a UTI is confirmed by culture .
and other causes of loin pain and/or fever have been excluded.
• People with severe symptoms, or signs or symptoms which suggest a

more serious illness or condition should be admitted to hospital.
• All other people should be offered an antibiotic.

o An antibiotic can be started once a midstream or catheter
specimen of urine has been obtained for culture and
sensitivity.
o For women who are not pregnant, and people with an

indwelling catheter
ciprofloxacin 500 mg twice a day for 7 days; trimethoprim
200mg twice a day for 14 days; co-amoxiclav 500/125 mg
three times a day for 7-10 days; or cefalexin 500mg twice or
three times a day (up to 1– 1.5g three or four times a day for
severe infections) for 7-10 days should be prescribed.
o
o For pregnant women who do not require admission — cefalexin 500mg
twice or three times a day (up to 1– 1.5g three or four times a day for
severe infections) for 7-10 days should be prescribed.


Acute
eMRCOG final revision mastitis
( Common infections & antibiotics )
reference is NICE guideline 2018
occurs in approximately 2–3% of postpartum women and the

incidence of lactation mastitis has been reviewed to be between 10-
33% in breast-feeding women .
Mastitis usually presents within 10–14 days of delivery and the

incidence decreases gradually after the first few weeks of delivery
Arrange hospital admission if :
• There are signs of sepsis (such as tachycardia, fever, and chills)
• The infection progresses rapidly.
• The woman is haemodynamically unstable or immunocompromised.
• The infant should be admitted with her to allow continuation of

breastfeeding.
• Arrange an urgent 2-week wait referral if there is an underlying

mass or breast cancer is suspected.
• Refer urgently to a general surgeon if a breast abscess is suspected

which can happen in approximately 3% of women with inadequately
treated acute mastitis.
Clinical signs and symptoms
Acute mastitis commonly presents as a hot, firm, erythematous

unilateral swelling of the breast, often in the upper outer quadrant
and the affected breast is usually tender on palpation. The symptoms

sometimes extend into the axilla and axillary lymphadenopathy may

be felt. Mastitis is occasionally associated pyrexia.
Although easy to recognise and treat, this condition can be
associated with much maternal anxiety and psychological morbidity
It is not possible to distinguish clinically between non-infectious and

infectious mastitis.
• Suspect if Symptoms do not improve (or are worsening) after 12–
24 hours despite effective milk removal .
• Or Breast milk culture is positive.
Infective mastitis develops when engorged breasts become colonised

by bacteria (usually skin commensals).
It is usually caused by an infection of commensal flora.
Non-infectious mastitis usually occurs when accumulated milk causes
an inflammatory response (congestive mastitis).
Subclinical mastitis is associated with inadequate milk removal and
poor infant weight gain .
Breast abscess
A breast abscess is a localised collection of pus within the breast that

occurs in around 3% of women. Suspect a breast abscess if there is:
• a recent history of mastitis

• a painful, swollen lump in the breast with redness, heat, and swelling
of the overlying skin
• fever and malaise ( NICE 2018)
Common pathogens
Usually skin flora are responsible for acute mastitis with the vast
majority of cases caused by Staphylococcus aureus, Staphylococcus
epidermidis, groups A, B, and F, beta-

haemolytic Streptococcus, Haemophilus influenzae and Escherichia

coli. A recent report showed an increase in the incidence of mastitis
caused by methicillin-resistant Staphylococcus aureus (MRSA)
Risk factors
Poor breastfeeding technique and failure to alternate between
breasts during feeds can result in nipple fissures, cracks and sore
which predispose to acute mastitis.
Other risk factors include not wearing a well-fitting maternity
support bra .
abrupt discontinuation of breastfeeding and past history of mastitis

Investigations :
Breast milk culture is not routinely required in primary care for

women with mastitis.
o However, in women with lactational mastitis, send a sample
of breast milk for microscopy, culture, and antibiotic
sensitivity, if:
▪ Mastitis is severe or recurrent.
▪ Hospital-acquired infection is likely.
▪ There is severe deep 'burning' breast pain (indicative of
ductal infection).
o Advise the women on how to collect a sample of breast
milk. She should:
▪ Clean the nipple of the affected breast.
▪ Express a small amount of milk by hand and discard it (to
avoid skin contamination).
▪ Express milk into a sterile container, avoiding touching
the inside of the container with the nipple or hands.
• All women with a breast abscess should be urgently referred to
secondary care for confirmation of the diagnosis and management
Treatment
Treat empirically with flucloxacillin 500 mg four times a day for

10–14 days.
If the woman is allergic to penicillin, prescribe either erythromycin

250–500 mg four times a day or clarithromycin 500 mg twice a day
for 10–14 days.

second line ( if no response of the above ttt)
Prescribe a second-line antibiotic, co-amoxiclav 500/125 mg

three times a day, for 10–14 days
review this choice when breast milk culture results become available
Seek specialist advice if the woman is allergic to penicillin.
Endometritis
Clinical signs and symptoms

Most women present with vaginal bleeding, lower abdominal/pelvic pain,
offensive lochia and pyrexia. Bleeding can be dramatic in the serious cases and
this is a common cause of secondary postpartum haemorrhage. Inadequately
treated cases can result in chronic endometritis with intrauterine adhesions
that may also present with dysmenorrhea and subfertility in due course.
Common pathogens
Endometritis has a multimicrobial aetiology,some will be found in normal
vaginal flora. It is often a mixed aerobic and anaerobic infection. There is
rarely microbiological confirmation of the cause.
Treatment
Mild cases can be managed on an outpatient basis with oral antibiotics such as
amoxicillin, gentamicin and metronidazole.
Most women will require a 5–7 day course of antibiotics).
If a woman is systematically unwell (pyrexia >38°C or significant per vaginal

bleeding), admission and treatment with intravenous antibiotics as cases of
sepsis .

Surgical site infections
prevention and treatment (in terms of antibiotics

usage )
• Do not use topical antimicrobial agents for surgical wounds that
are healing by primary intention to reduce the risk of surgical site
infection
• Do not use Eusol and gauze, or moist cotton gauze or mercuric
antiseptic solutions to manage surgical wounds that are healing
by secondary intention
• When surgical site infection is suspected by the presence of
cellulitis, either by a new infection or an infection caused by
treatment failure, give the patient an antibiotic that covers the
likely causative organisms. Consider local resistance patterns and
the results of microbiological tests in choosing an antibiotic.
For patients in hospital who have suspected infections, take

microbiological samples before prescribing an antimicrobial and
review the prescription when the results are available.

Cesarean section :
NICE recommend single dose of prophylactic antibiotics before

skin incision in C.S
a single dose of
first-generation cephalosporin or ampicillin
Prevent wound infection after instrumental delivery
Single dose of intravenous amoxicillin and clavulanic acid

should be
recommended following assisted vaginal birth
( within 3 hours of birth )as it significantly reduces
confirmed or suspected maternal infection.
PPROM :
Erythromycin should be given for 10 days following the

diagnosis of PPROM, or until the woman is in established labour
(whichever is sooner).


Bacterial Sepsis following Pregnancy

• Administration of intravenous broad-spectrum antibiotics within 1
hour of suspicion of severe sepsis, with or without septic shock, is
recommended as part of the Surviving Sepsis resuscitation care
bundle.
• If genital tract sepsis is suspected, prompt early treatment with a
combination of high-dose broadspectrum intravenous antibiotics
may be life saving.
• A combination of either piperacillin/tazobactam or a carbapenem
plus clindamycin provides one of the broadest ranges of treatment
for severe sepsis.
• MRSA may be resistant to clindamycin, hence if the woman is or is
highly likely to be MRSA-positive, a glycopeptide such as vancomycin
or teicoplanin may be added until sensitivity is known.
• Breastfeeding limits the use of some antimicrobials, hence the advice
of a consultant microbiologist should be sought at an early stage.
• Clindamycin is not nephrotoxic and switches off the production of
superantigens and other exotoxins. Therefore, together with either
piperacillin/tazobactam or a carbapenem, clindamycin provides
broad cover in severe sepsis.

Pelvic Inflammatory Disease
Some of the best evidence for the effectiveness of antibiotic

treatment in preventing the long term complications of PID comes
from the PEACH study where women were treated with cefoxitin
followed by doxycycline – pregnancy rates after 3 years were similar
or higher than those in the general population.
Outpatient Regimens
Ceftriaxone* 1000 mg single dose im followed

by oral doxycycline 100mg twice daily plus metronidazole
400mg twice daily for 14 days
oral ofloxacin 400mg twice daily plus oral metronidazole

400mg twice daily for 14 days
Alternative Regimens
Intramuscular ceftriaxone 1000 mg immediately, followed

by azithromycin 1 g/week for 2 weeks
• oral moxifloxacin 400mg once daily for 14 days
______________________________________________________

Inpatient Regimens Intravenous therapy should be continued

until 24 hours after clinical improvement and then switched to oral.
• i.v ceftriaxone 2g daily plus i.v. doxycycline 100mg twice daily (oral
doxycycline may be used if tolerated) followed by oral doxycycline
100mg twice daily plus oral metronidazole 400mg twice daily for a
total of 14 days
• i.v clindamycin 900mg 3 times daily plus i.v. gentamicin (2mg/kg

loading dose) followed by 1.5mg/kg 3 times daily [a single daily
dose of 7mg/kg may be substituted]) followed by either oral
clindamycin 450mg 4 times daily or oral doxycycline 100mg twice
daily plus oral metronidazole 400mg twice daily to complete 14
days
Alternative Regimens
• i.v. ofloxacin 400mg BD plus i.v. metronidazole 500mg TID for 14

days
• i.v. ciprofloxacin 200mg BD plus i.v. (or oral) doxycycline

100mg BD plus i.v. metronidazole 500mg TID for 14 days.
Pregnancy and Breastfeeding
• i.m. ceftriaxone plus oral or i.v. erythromycin, with the

possible addition of oral or i.v. metronidazole 500mg 3 times
daily in clinically severe disease) (Grade C [IV]).

Management of Vaginal Discharge in Non-Genitourinary

Medicine Settings
Bacterial vaginosis
• Metronidazole and clindamycin administered either orally or vaginally are
effective in the treatment of BV.
• In the management of BV, testing and treatment of male sexual partners is not
indicated but testing and treatment of female sexual partners can be considered
Vulvovaginal candidiasis
• Vaginal and oral azole antifungals are equally effective in the treatment of VVC.
• Women with vulval symptoms of VVC may use topical antifungals (in addition to
oral or vaginal treatment) until symptoms resolve.
• There is no need for routine screening or treatment of sexual partners in the

management of candidiasis.
Treatment of sexually transmitted infections
• Oral nitroimidazole drugs (e.g. metronidazole) are effective in treating

trichomoniasis.
• Current sexual partners of women diagnosed with TV should be offered a full

sexual health screen and should be treated for TV irrespective of the results of
their tests.
Pregnancy and breast feeding

• Women with BV who are pregnant or breastfeeding may use metronidazole 400
mg twice daily for 5–7 days or intravaginal therapies.
• A 2 g stat dose of metronidazole is not recommended in pregnancy or

breastfeeding women.
• Women with VVC in pregnancy should avoid oral antifungals.

• Women with VVC in pregnancy can be treated with topical imidazoles. Single-
dose treatment is less effective than longer regimens of up to 7 days.
HIV patients and recurrent vaginal discharge

• For HIV-positive women with TV, longer treatment regimens with oral
metronidazole may be more effective than a single dose.
• For women with recurrent BV, suppressive treatment with metronidazole vaginal
gel may be considered.
• Women using acidifying gels for recurrent BV can be advised to use them
alternate evenings for 1 month or longer if required.
• For women with recurrent VVC, an induction and maintenance regimen may be
used for 6 months.
• Recurrent TV is usually due to re-infection, but consideration should be given to

the possibility of drug resistance
Contraception and vaginal discharge
• Additional contraceptive precautions are not required when using antibiotics

that do not induce liver enzymes.
• Women and male partners should be advised that latex contraceptives may be
damaged by some vaginal/vulval antifungal treatments
• Women using CHC who experience recurrent VVC may wish to consider
switching to an alternative method of contraception.
• Women with a Cu-IUD who experience recurrent BV may wish to consider
switching to
an alternative method of contraception.

Organism Discharge Test Treatment
Gonorrhoea
eMRCOG final
Mucopurulent
revision ( Common
(NAATs) or by
infections & antibiotics )
Ceftriaxone 1g intramuscularly as a single dose
endocervical culture. NAATs
discharge are more
or
sensitive than
culture, spectinomycin 2 gm IM as a single dose (caution
particularly for with breastfeeding as excreted in breast milk)
oropharyngeal azithromycin 2 g oral as a single dose.
and rectal sites
Chlamydia Mucopurulent NAATs 1. Doxycycline 100mg bd for seven days
by vulvo-vaginal (contraindicated in pregnancy)
Dysuria sample is
2. (2) Azithromycin 1g orally as a single
lower Abd pain the specimen of
deep dyspareunia choice in women dose, followed by 500mg once daily for
cervical motion two days
tenderness
Mycoplasma Muco-purulent NAATs Doxycycline 100mg bd for seven days followed

genitalium cervicitis by azithromycin 1g orally as a single dose then
culture is not
500mg orally once daily for 2 days.
post coital useful in
bleeding diagnosis
Moxifloxacin 400mg orally once daily for 10
sample by days if organism known to be macrolide-
vaginal swab in resistant or where treatment with azithromycin
women has failed
1 st catch urine in
men
Trichomonas Classical frothy By Swab taken Metronidazole 2g orally in a single dose or

vaginalis yellow discharge from posterior Metronidazole 400-500mg twice daily for 5-7
can be thin scanty fornix
days
or thick
Detection of Alternative regimens
vulval itching & motile Tinidazole 2g orally in a single dose
trichomonas by
( Strawberry
cervix) light-field
microscopy
within 10
minutes of
sample
Or
NAAT

Treatment of Candida .
Acute VVC
Recommended regimen:
• Fluconazole* capsule 150mg as a single dose, orally
Recommended topical regimen (if oral therapy
contraindicated):
• Clotrimazole pessary 500mg as a single dose,
intravaginally .
*Oral therapies must be avoided in pregnancy, risk of

pregnancy and breastfeeding topical imidazole’s are a safe
and effective alternative in these situations
Severe Vulvovaginal Candidiasis

In patients with severe VVC
(i.e. extensive vulval erythema, oedema, excoriation,

and fissure formation)
Recommended regimen:
• Fluconazole 150mg orally on day 1 and 4
Alternative regimens:
Clotrimazole 500mg pessary intravaginally on day 1 and 4
Miconazole vaginal capsule 1200mg on day 1 and 4

Recurrent VVC ( 4 episodes / year )

Recommended Regimen:
Induction: fluconazole 150mg orally every 72 hours x 3 doses

Maintenance :
fluconazole 150mg orally once a week for 6 months *
Alternative Regimens:
Induction : topical imidazole therapy can be increased to 7-14 days

according to symptomatic response
Maintenance for 6 months :
o Clotrimazole pessary500mg intravaginally once aweek
Itraconazole50-100mg. Orally daily *
* Oral therapies must be avoided in pregnancy, risk of pregnancy and

breastfeeding
Non-albicans Candida species and azole resistance
Recommended Regimen:
• Nystatin pessaries 100,000units intravaginally at night for 12-14

consecutive nights
Alternative Regimens:
Boric acid vaginal suppositories 600mg daily for 14 days*

Amphotericin B vaginal suppositories 50mg once a day for 14 days
Flucytosine 5g cream or 1g pessary intravaginally with amphotericin or
nystatin daily for 14 days
* Avoid in pregnancy or risk of pregnancy

Recurrent VVC due to azole resistant Candida:
Nystatin pessaries 100,000units intravaginally at night for 14 nights per

month for 6 months.
Consider 14 days per month for 6 month of the alternative regimens
Pregnancy & Breastfeeding
Recommended regimens (acute VVC in pregnancy):

• Clotrimazole pessary 500mg intravaginally at night for up to 7 consecutive
nights*
Recommended regimen (recurrent VVC in pregnancy):
Induction: topical imidazole therapy can be increased to 10-14 days

according to symptomatic response
Maintenance: Clotrimazole pessary 500mg intravaginally weekly
Recommended regimens (acute and recurrent VVC in breastfeeding):

• Treatment regimens using topical imidazoles should be as per the
recommendations listed above for non-pregnant women with acute and
recurrent VVC

Herpes :
Clinical features
Symptoms .
The patient may be asymptomatic, and the disease unrecognized. .
Local symptoms consist of painful ulceration, dysuria, vaginal or
urethral discharge. . Systemic symptoms are much more common in
primary than in non-primary or recurrent disease. .
Systemic symptoms consist of fever and myalgia. . Rarely, systemic

symptoms may be the only evidence of infection.
Signs .
Blistering and ulceration of the external genitalia or perianal region

(cervix/rectum) classic multiple painful shallow ulcers .
Tender inguinal lymphadenitis, usually bilateral.

In first episodes, lesions and lymphadenitis are usually bilateral.
In recurrent disease, it is usual for lesions to affect favored sites.

They may alternate between sides but are usually unilateral for each
episode.
Lymphadenitis occurs in around 30% of patients. . Recurrent

outbreaks are limited to the infected dermatome.
sample : Swabs taken from the base of the anogenital lesion or the
rectal mucosa in the case of proctitis.
detection by NAAT

First episode genital herpes
General advice .
Saline bathing . Analgesia . Topical anaesthetic agents, e.g. 5%

lidocaine (lignocaine) ointment may be useful to apply especially
prior to micturition.
Suprapubic catheter is recommended in cases of acute episode and
urine retention .
Antiviral drugs u Recommended regimens (all for 5 days):
Preferred regimens:
Acyclovir 400 mg three times daily Valaciclovir 500 mg twice daily
Alternative regimens:
Acyclovir 200 mg five times daily Famciclovir 250 mg three times

daily


For patients who report possible sensitivity to penicillin and who can
tolerate cephalosporins, the alternative is ceftriaxone 500 mg
intramuscularly, daily for 10 days.
• In light of increasing macrolide resistance in T. pallidum and the

inability of macrolides to cross the placenta in adequate quantities,
macrolide antibiotics, such as erythromycin and azithromycin, have
now been removed from the BASHH guideline
If a patient is not penicillin‐allergic but unable to tolerate an

intramuscular regime, the alternative is amoxicillin 500 mg and
probenecid 500 mg, both orally, four times per day for 14 days

Chancroid
• caused by infection with Haemophilus ducreyi, presents with
anogenital ulceration and lymphadenitis with
progression to bubo (abscess) formation. The incubation period
ranges from between 3 and 10 days following
• The time from infection during sexual contact to the onset of signs and symptoms is
typically 4–10 days (range 1–35 days)
.An infected person initially develops one or more

red erythematous papules, which quickly evolve to pustules and become
larger until they break down into an ulcer. A typical ulcer is deep, has
shaggy undermined borders and is very painful. The base of the ulcer has
a purulent exudate and bleeds easily.
Women generally have nonspecific symptoms such as painful urination or pain on

defecation, vaginal discharge, dyspareunia, and rectal bleeding. Some women
are asymptomatic carriers and are unaware of the infection
• The diagnosis can be confirmed by culture of the infecting

organism or ELISA.
• however, a clinical diagnosis is often made by considering the
clinical features, having excluded syphilis and herpes.
First-line treatment is:
• azithromycin 1 g orally stat or

• ceftriaxone 250 mg intramuscularly stat
• Treatment of H. influenze-associated infections:

• cephalosporins.

Lymphogranuloma venereum
LGV is a long-term (chronic) infection of the lymphatic system. It is

caused by any of three different types (serovars) of the
bacteria Chlamydia trachomatis.
LGV is more common in men than women.
The main risk factor is being HIV-positive
respond to antibiotic treatment with doxycycline and azithromycin

Tubo ovarian abscess

• Diagnosis is made by combining the clinical picture (fever, pelvic pain and
pelvic adnexal mass) with raised inflammatory markers and radiological
findings demonstrating an abscess.
• Initial management with intravenous antibiotics may not be successful.
• Surgical intervention may be indicated but the optimal timing is not clear
and image‐guided drainage can be a possible alternative to surgery.
• Surgery may be conservative or involve pelvic clearance and will depend
on the clinical situation
It most commonly affects women of reproductive age and nearly 60% of

women with TOA are nulliparous
PID and TOAs can be caused by a variety of organisms . in 30–40% of

cases, PID is polymicrobial .
When associated with severe systemic sepsis, the mortality rate is

reported to be as high as 5–10%
Around 15–35% of women being treated for proven PID will be diagnosed
with a TOA.
Chronic pelvic pain is a potential long‐term complication in around one‐

third of women with TOAs and is related to severity and number of
episodes.
The incidence of chronic pelvic pain has been shown to be 12% after one
episode, 30% after two episodes and 67% after three or more episodes of
PID or TOA
Subfertility is a potential long‐term complication of TOA.

32–63% of women achieved a pregnancy following laparoscopy and
drainage of abscess versus 4–15% in women treated with antibiotics
alone. Laparoscopy and drainage of abscesses should be considered for all
women with TOAs who desire future fertility.

Cogwheel sign resulting from thickened end salpingeal folds.
Antibiotic regimens for a tubo‐ovarian abscess
IV ofloxacin 400 mg twice‐daily plus intravenous (IV) metronidazole 500 mg three

times a day
IV clindamycin 900 mg three times a day plus IV gentamicin
IV cefoxitin 2 g three times a day plus IV/PO doxycycline 100 mg twice‐daily
IV ciprofloxacin 200 mg twice‐daily plus IV/PO doxycycline 100 mg twice‐daily plus

IV metronidazole 500 mg three times a day



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2020/

Antibiotic use in obstetrics and

Urinary tract infections

Q- What is the most common causative organism ?

Ecoli Gram negative rods accounts for >50%

Specimens of urine provided by postpartum women are frequently

• The presence of leukocytes, protein and blood in a mid-

• Significant bacteriuria is taken as >100,000 CFU/ml and an

What are the Consideration of Drug safety during

WWW.emrcog.com WhatsApp : +447376394692

Q- what is the role of Gentamicin ?

• Gentamicin is useful for recurrent and unusual cases. In these

Pyelonephritis key points ( in both pregnant and postoperative )

Acute pyelonephritis is an infection of one or both kidneys usually

• Complications of acute pyelonephritis include:

• Acute pyelonephritis should be suspected in people with signs

WWW.emrcog.com WhatsApp : +447376394692

• A midstream or catheter specimen of urine should be sent for culture

• A final diagnosis of acute pyelonephritis should be made in people

• People with severe symptoms, or signs or symptoms which suggest a

• All other people should be offered an antibiotic.

o For women who are not pregnant, and people with an

WWW.emrcog.com WhatsApp : +447376394692

WWW.emrcog.com WhatsApp : +447376394692

occurs in approximately 2–3% of postpartum women and the

Mastitis usually presents within 10–14 days of delivery and the

Arrange hospital admission if :

• There are signs of sepsis (such as tachycardia, fever, and chills)

• The infection progresses rapidly.

• The woman is haemodynamically unstable or immunocompromised.

• The infant should be admitted with her to allow continuation of

• Arrange an urgent 2-week wait referral if there is an underlying

• Refer urgently to a general surgeon if a breast abscess is suspected

Clinical signs and symptoms

Acute mastitis commonly presents as a hot, firm, erythematous

WWW.emrcog.com WhatsApp : +447376394692

sometimes extend into the axilla and axillary lymphadenopathy may

It is not possible to distinguish clinically between non-infectious and

Infective mastitis develops when engorged breasts become colonised

A breast abscess is a localised collection of pus within the breast that

• a recent history of mastitis

WWW.emrcog.com WhatsApp : +447376394692

haemolytic Streptococcus, Haemophilus influenzae and Escherichia

WWW.emrcog.com WhatsApp : +447376394692

Breast milk culture is not routinely required in primary care for

Treat empirically with flucloxacillin 500 mg four times a day for

If the woman is allergic to penicillin, prescribe either erythromycin

WWW.emrcog.com WhatsApp : +447376394692

second line ( if no response of the above ttt)

Prescribe a second-line antibiotic, co-amoxiclav 500/125 mg

Seek specialist advice if the woman is allergic to penicillin.

Clinical signs and symptoms

If a woman is systematically unwell (pyrexia >38°C or significant per vaginal

WWW.emrcog.com WhatsApp : +447376394692

Surgical site infections

prevention and treatment (in terms of antibiotics

For patients in hospital who have suspected infections, take

WWW.emrcog.com WhatsApp : +447376394692

NICE recommend single dose of prophylactic antibiotics before

Prevent wound infection after instrumental delivery

Single dose of intravenous amoxicillin and clavulanic acid

Erythromycin should be given for 10 days following the

WWW.emrcog.com WhatsApp : +447376394692