Chorioamnionitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Overview
Antimicrobial therapy is indicated among patients with chorioamnionitis. The preferred regimen is a combination of ampicillin and gentamicin. Supportive therapy, such as antipyretics, may also be used.
Medical Therapy
Medical therapy for chorioamnionitis includes antimicrobial therapy and supportive therapy:
- Preferred regimen: Ampicillin 2 g IV q6h AND (Gentamicin 1.5- mg/kg IV q8h OR Gentamicin 5 mg/kg IV q24h) until the delivery or Ampicillin/Sulbactam 3 g IV q6h until the delivery
- Alternative regimen, penicillin-allergic: Clindamycin 900 mg IV q8h OR Vancomycin 1 g IV q12h OR Erythromycin (500 mg-1 g) IV q6h until the delivery
- Note (1): For patients with cesarean section, add Clindamycin 900 mg IV in a single dose only after clamping the umbilical cord (Metronidazole 500 mg IV is an alternative).
- Note (2): For patients with cesarean section who are penicillin-allergic, Metronidazole should be avoided post-partum.
- Preferred regimen: Acetaminophen (325–650 mg) q(4-6)h PO (maximum, 4 g per day) as an antipyretic.
- Note (1): At least single dose of antenatal corticosteroids might decreased the neonatal mortality without causing an adverse outcomes (execarbation of infection or neonatal sepsis), therefore, it might be beneficial for women with clinical chorioamnionitis (gestational age between 24 0/7 and 33 6/7).
- Note (2): While magnesium sulfate is a neuroprotective and decreases the risk of cerebral palsy, it should be recommended for women with clinical chorioamnionitis (gestational age between 24 0/7 and 33 6/7).
References
- ↑ 1.0 1.1 ACOG Committee on Practice Bulletins-Obstetrics (2007). "ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists". Obstet Gynecol. 109 (4): 1007–19. doi:10.1097/01.AOG.0000263888.69178.1f. PMID 17400872.
- ↑ Tita AT, Andrews WW (2010). "Diagnosis and management of clinical chorioamnionitis". Clin Perinatol. 37 (2): 339–54. doi:10.1016/j.clp.2010.02.003. PMC 3008318. PMID 20569811.
- ↑ 3.0 3.1 Conde-Agudelo A, Romero R, Jung EJ, Garcia Sánchez ÁJ (December 2020). "Management of clinical chorioamnionitis: an evidence-based approach". Am J Obstet Gynecol. 223 (6): 848–869. doi:10.1016/j.ajog.2020.09.044. PMID 33007269 Check
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