Antibiotic therapy during labour – The slovenian recommendations

Abstract

Antibiotic agents are administered during the intrapartum period to prevent and treat maternal infection and to prevent neonatal disease. Short courses of antibiotics are used during labour to prevent such infections as group B streptococci (GBS) in newborns, postpartum endometritis and to treat chorioamnionitis. Many trials have evaluated the use of prophylactic antibiotics to prolong the pregnancy (and subsequently improve neonatal outcomes) after premature rupture of membranes (PROM). Intravenous antibiotics recommended for women in active preterm labour are: Penicillin G: given initially as 3 g (or 5MU) intravenously and then 1.5 g (or 2.5MU) at 4-hour intervals until delivery. For women allergic to penicillin: provided a woman has not had severe allergy to penicillin, a cephalosporin should be used. If there is any evidence of severe allergy to penicillin, vancomycin should be used. For women allergic to penicillin, Clindamycin is no longer recommended as the current resistance rate is high. Where infection of the membranes is diagnosed or suspected or where there is preterm prolonged rupture of membranes, broad-spectrum intravenous antibiotics should be given, which include adequate GBS cover (we recommend Cefazolin 2 g i.v and then 1 g at 8-hour intervals until delivery). In PPROM we recommend as soon as possible after PPROM: ampicillin (2 g i.v. every 6 hours) for 48 hours plus azithromycin (1 g po in onetime administration), followed by amoxicillin (500 mg po every 8 hours) for 5 days unless delivery occurs.