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Antibiotics in obstetrics & gynae

GBS, caesarean, instrumental birth, sepsis, PID, endometritis.

Source: RCOG GTG 36 · 26 · 64 (2024) · BASHH

BenzylpenicillinGBS3 g IV load, then 1.5 g IV 4-hourly until birth.⚠ Mild allergy: cefuroxime 1.5 g then 750 mg 8-hourly. Severe: vancomycin 1 g 12-hourly.

CefuroximeCaesarean1.5 g IV before skin incision (± metronidazole 500 mg per unit).⚠ Severe allergy: clindamycin + gentamicin.

Co-amoxiclavInstrumental birth1.2 g IV single dose within 6 h of birth (ANODE).⚠ Penicillin allergy: clindamycin 600 mg IV.

Piperacillin–tazobactamSeptic shock4.5 g IV QDS + clindamycin 1.2 g QDS + gentamicin.⚠ Within 1 hour; follow local microbiology.

Ceftriaxone + doxy + metroPID (outpatient)Ceftriaxone 1 g IM stat; doxycycline 100 mg BD + metronidazole 400 mg BD for 14 days.⚠ Avoid doxycycline in pregnancy.

Co-amoxiclavEndometritisWell: 625 mg TDS oral 7 days. Unwell: 1.2 g IV TDS.⚠ Allergy: clindamycin + gentamicin.

A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.