Chorioamnionitis medical therapy

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Antimicrobial Therapy

Chorioamnionitis/Septic Abortion Treatment Preferred Regimen ▸ Cefoxitin 2 gm IV q6–8h OR ▸ Ticarcillin-Clavulanate 3.1 gm IV q4–6h OR ▸ DoripenemNAI 500 mg IV q8h OR ▸ Imipenem 0.5 gm IV q6h OR ▸ Meropenem 1 gm IV q8h OR ▸ Ampicillin-Sulbactam 3 gm IV q6h OR ▸ Ertapenem 1 gm IV q24h' OR ▸ Pipracillin-Tazobactam 4.5 gm IV q6h (or 4-hr infusion of 3.375 gm q8h) PLUS ▸ Doxycycline 100 mg IV/po q12h OR ▸ Clindamycin 450–900 mg IV q8h PLUS ▸ Ceftriaxone 2 gm IV q24h OR ▸ Gentamicin MDD: 2 mg per kg load, then 1.7 mg per kg q8h or OD: 5.1 (7 if critically ill) mg per kg q24h

• Antimicrobial therapy should be started once the diagnosis is confirmed to improve maternal and fetal outcomes.
• Cesarean section is preserved only for obstetrics indications, and antimicrobial coverage for anaerobes is required for such cases.
• A single daily dose of gentamicin is preferred than multiple doses a day. It has better efficacy and less toxicity.
• Short term regimen(24 hours after fever resolution)has the same efficacy as prolonged regimen.
• Current recommendations are against corticosteroids use for women with intraamniotic infection.
• No proven benefit has been shown of using antimicrobial prophylaxis.

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.