Chorioamnionitis medical therapy: Difference between revisions
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{{Chorioamnionitis}} | {{Chorioamnionitis}} | ||
== | *1. '''Antibiotics''' <ref name="pmid20569811">{{cite journal| author=Tita AT, Andrews WW| title=Diagnosis and management of clinical chorioamnionitis. | journal=Clin Perinatol | year= 2010 | volume= 37 | issue= 2 | pages= 339-54 | pmid=20569811 | doi=10.1016/j.clp.2010.02.003 | pmc=PMC3008318 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20569811 }} </ref> | ||
:* Preferred regimen: [[Ampicillin]] 2 g IV q6h {{or}} [[Penicillin]] 5x10<sup>6</sup> units IV q6h {{and}} [[Gentamicin]] 1.5 mg/kg q8h | |||
| | :* Note (1): [[Cephalosporins]] are generally recommended for women with chorioamnionitis who are allergic to [[Penicillin]] | ||
:* Note (2): In women with anaphylaxis to [[Penicillin]] a recommendation is to substitute [[Clindamycin]] 900 mg q8h | |||
:* Note (3): In the non-obstetric population, daily dosing of [[Gentamicin]] appears to be more effective, convenient, and cost-effective as well as less toxic. | |||
:* Note (4): Recommends the addition of a drug with enhanced anaerobic coverage, such as [[Clindamycin]] q8h {{or}} [[Metronidazole]], in those cases of chorioamnionitis that require cesarean delivery | |||
:* Note (5): chorioamnionitis is a contraindication to the administration of [[Corticosteroids]]. Women with intra-amniotic infection have traditionally been excluded from randomized trials of corticosteroid therapy. | |||
*2. '''Supportive measures''' | |||
:* Preferred regimen: Antipyretics ([[Acetaminophen]]) | |||
*3. '''Prevention''' <ref name="pmid21962477">{{cite journal| author=Fishman SG, Gelber SE| title=Evidence for the clinical management of chorioamnionitis. | journal=Semin Fetal Neonatal Med | year= 2012 | volume= 17 | issue= 1 | pages= 46-50 | pmid=21962477 | doi=10.1016/j.siny.2011.09.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21962477 }} </ref> | |||
:* Preferred regimen: Macrolide ([[Erythromycin]] {{or}} [[Azithromycin]]) {{and}} [[Ampicillin]] for 7–10 days via intravenous (2 days) followed by oral routes. | |||
:* Note: Induction of labor and delivery for preterm premature rupture of membranes (PPROM) after 34 weeks’ gestation is recommended. | |||
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==Antipyretic Therapy== | ==Antipyretic Therapy== | ||
Revision as of 17:53, 12 August 2015
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- 1. Antibiotics [1]
- Preferred regimen: Ampicillin 2 g IV q6h OR Penicillin 5x106 units IV q6h AND Gentamicin 1.5 mg/kg q8h
- Note (1): Cephalosporins are generally recommended for women with chorioamnionitis who are allergic to Penicillin
- Note (2): In women with anaphylaxis to Penicillin a recommendation is to substitute Clindamycin 900 mg q8h
- Note (3): In the non-obstetric population, daily dosing of Gentamicin appears to be more effective, convenient, and cost-effective as well as less toxic.
- Note (4): Recommends the addition of a drug with enhanced anaerobic coverage, such as Clindamycin q8h OR Metronidazole, in those cases of chorioamnionitis that require cesarean delivery
- Note (5): chorioamnionitis is a contraindication to the administration of Corticosteroids. Women with intra-amniotic infection have traditionally been excluded from randomized trials of corticosteroid therapy.
- 2. Supportive measures
- Preferred regimen: Antipyretics (Acetaminophen)
- 3. Prevention [2]
- Preferred regimen: Macrolide (Erythromycin OR Azithromycin) AND Ampicillin for 7–10 days via intravenous (2 days) followed by oral routes.
- Note: Induction of labor and delivery for preterm premature rupture of membranes (PPROM) after 34 weeks’ gestation is recommended.
Antipyretic Therapy
Acetaminophen use for febrile patients with chorioamnionitis has shown remarkable improvement in fetal vitals and acid-base balance, with no increased risk for complications.
References
- ↑ 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.
- ↑ Fishman SG, Gelber SE (2012). "Evidence for the clinical management of chorioamnionitis". Semin Fetal Neonatal Med. 17 (1): 46–50. doi:10.1016/j.siny.2011.09.002. PMID 21962477.