Chorioamnionitis medical therapy
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Overview
Antimicrobial therapy is indicated in chorioamnionitis. The preferred regimen is Gentamicin and either Ampicillin or Penicillin.
Medical Therapy
- 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.
- 4. 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.