PROCEDURE 1ST choice 2nd choice 2nd choice

(mild penicillin (severe penicillin

allergy) allergy)
 Elective Caesarian section Amoxicillin- 1st or 2nd generation Gentamicin 3mg/kg
clavulanic acid cephalosporin 2g IV + clindamycin
1.2g IV 600mg IV
 Manual removal of the placenta Amoxicillin- st nd
1 or 2 generation Gentamicin 3mg/ kg
 Perineal tear involving anus/ rectum clavulanic acid cephalosporin 2g + IV + clindamycin
1.2g IV Metronidazole 500mg 600mg IV
IV
 Hysterectomy Amoxicillin- 1st or 2nd generation Gentamicin 3mg/ kg
 Laparotomy clavulanic acid cephalosporin 2g + IV + clindamycin
 Vaginal Repair 1.2g IV Metronidazole 500mg 600mg IV
IV
 Diagnostic and operative laparoscopy
(where vaginal vault not opened)
 Laparoscopic/hysteroscopic
sterilization Antibiotic prophylaxis not routinely recommended
 Diagnostic/operative hysteroscopy
 Endometrial biopsy
 Surgical termination of pregnancy
 Evacuation of retained products of
conception (1st trimester) Metronidazole 400 mg PO or 1g PR + Azithromycin 1g PO (to
 Hysterosalpingogram cover one hour pre- operatively)

Prophylactic antibiotic recommendations for obstetrical procedures

 Procedure Antibiotic Dosage Level of Evidence
Emergency or elective First or second- generation 1-2 g IV I-A
caesarian section (no labour, no cephalosporin
rupture of membranes)
If penicillin allergic First or second- generation 600 mg IV
cephalosporin 500 mg IV
Operative vaginal delivery First or second- generation N/A II-1C
cephalosporin
Manual removal placenta First or second- generation N/A III-L
cephalosporin
Repair third or fourth degree First or second- generation 1g IV I-B
laceration cephalosporin
Postpartum dilatation and First or second- generation N/A No evidence
curettage cephalosporin
Cercelage First or second- generation N/A II- 3C
cephalosporin

Adult Obstetric and Gynaecology Antibiotic

Prophylaxis Guidelines
 Administer prophylactic intravenous antibiotics 30-60 minutes prior to surgical
incision/procedure (oral and rectal antibiotics must be given one hour prior to the
procedure)
Intra-operative doses are required if:
(1) Blood loss is = 1500mls
(2) Surgery lasts longer than 4 hours (excluding gentamicin)
Additional post-operative prophylactic doses,up to 24 hours total, may be given if there is:
(1) gross spillage from a viscus, (2) devitalised viscus or (3) major break in
sterile technique
If an infection is discovered e.g. pus or peritonitis, an appropriate course of antibiotic
treatment should be prescribed
Check MRSA status before prescribing prophylaxis
Treat unscreened patients, and patients with a history of MRSA as positive
unless cleared by infection control
Check allergy status
Severe penicillin allergy e.g. angioedema, anaphylaxis or Stevens-Johnson
syndrome – avoid all beta-lactams
Patients with non-urticarial rash allergy to penicillin may receive
cephalosporins in a controlled environment
All antibiotic doses are for adults with normal renal function. Gentamicin doses should be
rounded to the nearest 80mg