Procedure |
Recommended antibiotic regimen |
Comments |
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Caesarean Section
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Co-amoxiclav IV 1.2g or in penicillin allergy Clindamycin IV 600 mg |
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3rd Degree Tear
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Co-amoxiclav IV 1.2g or in penicillin allergy Clindamycin IV 600 mg
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6 hours later second dose of IV co-amoxiclav 1.2g or in penicillin allergy
No repeat dosing of gentamicin. |
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4th Degree Tear |
Co-amoxiclav IV 1.2g or in penicillin allergy Clindamycin IV 600 mg |
6 hours later second dose of IV co-amoxiclav 1.2g or in penicillin allergy IV Clindamycin 600mg Then Oral Co-amoxiclav 625mg 8 hourly for total duration (IV/oral) 5 days Oral clindamycin 600mg 8 hourly for total duration (IV/oral) 5 days
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Manual removal of Placenta |
Co-amoxiclav IV 1.2g or in penicillin allergy Clindamycin IV 600 mg
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Specific antibiotic prophylaxis recommended for patients with proven Chlamydia or gonorrhoea
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Pre-term, pre-labour rupture of membranes. |
Erythromycin oral 250mg 6 hourly for 10 days |
Prophylaxis only required if no evidence of chorioamnionitis Erythromycin serious drug interations (see BNF Appendix 1) and QTc prolongation |
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Group B streptococcus prophylaxis (specific) |
Benzylpenicillin IV 3g or in penicillin allergy
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Always give IAP however soon the lady is likely to deliver. Teicoplanin# based on most recent body weight - round to nearest 100mg (max dose 800mg) |
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Operative Vaginal Births (To be given ASAP after delivery, and no more than 6 hours after delivery) |
Co-amoxiclav IV 1.2g or in penicillin allergy Clindamycin IV 600 mg |
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[CG] Antibiotic Prophylaxis in Obstetric Procedures
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Objectives
NHS Greater Glasgow and Clyde recommendations for antibiotic prophylaxis in Obstetric Procedures
Please report any inaccuracies or issues with this guideline using our online form |
Single dose, IV prophylaxis ≤ 60mins prior to skin incision/ intervention.
Gentamicin*
- Please use the GGC gentamicin dose calculator to calculate the gentamicin dose. or use dose banding table in Appendix 1.
- Doses of up to 400mg gentamicin can be given by slow IV injection over 3 – 5 minutes.
- If subsequent treatment using gentamicin is required, measure gentamicin concentrations 6-14 hours post theatre gentamicin dose and follow GGC guidance on staffnet for gentamicin dosing. Calculate the dose using the online calculator. Discuss with pharmacy if further advice required (or if out of hours on call pharmacist).
If >1.5L blood loss: replace fluid and repeat antibiotic dose intra-operatively: benzyl penicillin, clindamycin, co-amoxiclav (with amoxicillin for weight >100kg) . Gentamicin should be re-dosed at half prophylaxis dose. Give half the original teicoplanin dose if ≥ 1.5L blood loss within the first hour of operation.
If surgery prolonged >4hrs post first antibiotic dose: repeat amoxicillin, benzyl penicillin, clindamycin, co-amoxiclav (with amoxicillin for weight >100kg); >8hrs post first antibiotic dose - repeat amoxicillin, benzyl penicillin, clindamycin, co-amoxiclav (with amoxicillin for weight >100kg), and if eGFR > 60mls/min/ 1.73m2 gentamicin (full prophylactic dose). No repeat dosing of teicoplanin if surgery prolonged.
MRSA: decolonise prior to procedure as per NHS GGC infection control guidelines and discuss with microbiology re antibiotic choice.
CPE carriers: For those patients who have been identified as CPE (carbapenemase producing enterobacteriaceae) carriers, contact microbiology
Weight > 80Kg
Increase the dose of antibiotic as below:
>100 Kg | ||
Co-amoxiclav | add 1g IV amoxicillin to 1.2g IV co-amoxiclav | |
>80 Kg | > 160 Kg | |
Clindamycin | 900mg | 1200 mg |
- Prophylactic gentamicin dosing is based on patient height and approximates to 5mg/kg/ideal body weight, capped at 400mg.
- Doses of gentamicin can be given by slow IV injection over 3-5 minutes.
- Patients receiving aminoglycosides as a slow IV bolus should be closely monitored for other signs of extravasation or infiltration e.g. swelling, redness, coolness or blanching at the cannula insertion site.
- Avoid gentamicin if eGFR< 20mls/min/1.73m2: seek advice on alternative from microbiology. In renal transplant patients avoid gentamicin and seek advice from microbiology or renal team.
Height ranges (cm) |
Gentamicin Dose (mg) |
Females |
|
142 - 146 |
200 |
147 - 154 |
240 |
155 - 164 |
280 |
165 - 174 |
320 |
≥ 175 |
400 |