gynae/ obstetrics & antibiotics
TRANSCRIPT
Gynaecology/ Obstetricsand
Antibiotics
Deurali-Janta Pharmaceuticals Pvt. Ltd.
Phr. Asad KamranDJPL
Caesarean SectionAntibiotic Prophylaxis
UTI Management In Pregnancy
Infectious morbidity remains a leading cause of postoperative complications
following Caesarean delivery.
Caesarean Section Antibiotic Prophylaxis
In Caesarean Delivery there is 5-20 fold increased risk of infection
compared to vaginal birth.
“Cochrane Database”
Caesarean Section Antibiotic Prophylaxis
Pre/ Post Caesarean Section Antibiotic Prophylaxis is mostly
RECOMMENDED.
Caesarean Section Antibiotic Prophylaxis
Purpose!
Caesarean Section Antibiotic Prophylaxis
Preventing Infectious complications;Surgical Site Infection (SSI)EndometritisFeverWound InfectionUrinary Tract Infection
Reducing postoperative maternal infectious morbidity (rate of incidence of disease).
Caesarean Section Antibiotic Prophylaxis
Recommended Antibiotics
Caesarean Section Antibiotic Prophylaxis
Pre-operative:Cefazolin IV
Post-Operative:NitrofurantoinCefadroxilCefalexinMetronidazole
Caesarean Section Antibiotic Prophylaxis
Pyelonephritis & Preterm Delivery
Prevention!All bacteriuria in pregnancy requires
treatment…!
(Cochrane Guideline A)
UTI Management in Pregnancy
UTI Management in Pregnancy
Asymptomatic bacteriuria – 3 days treatment.Acute cystitis – 7 days treatment.Pyelonephritis - 10-14 days treatment.
Regular Urine cultures - ensure eradication of the organism.
15% of the women - recurrent bacteriuria during the pregnancy.
The choice of antibiotic depends on the sensitivities of the causative
organism & its safety.
UTI Management in Pregnancy
Penicillins (Amoxicillin) & cephalosporins are safe & appropriate antibiotics in
pregnancy…!
UTI Management in Pregnancy
Augmentin (Co-AmoxiClav) - risk of necrotizing enterocolitis in the neonates.
“Cefadroxil 500mg BD is effective against the majority of urinary
pathogens.”Nitrofurantoin should be avoided in the third trimester as it may cause haemolytic anaemia in the neonates.
Trimethoprim should be avoided in the first trimester because of its anti-folate action.
UTI Management in Pregnancy
Continuous prophylactic antibiotics are usually recommended only for those with two or more
confirmed (with a positive culture) UTIs & either one of risk factors (hydronephrosis, congenital abnormalities & renal calculi) or in those with
renal transplants.
UTI Management in Pregnancy
Suggested Treatment regimens for Urinary Tract Infections
(UTIs) in Pregnancy!
UTI Management in Pregnancy
Oral Antibiotics:•Amoxicillin 500mg three times a day •Cefadroxil 500mg two times a day•Cephalexin 250mg three times a day•Nitrofurantoin 100mg three times a day (not third trimester)•Trimethoprim 200mg two times a day (not first trimester)Intravenous antibiotics for pyelonephritis•Cefuroxime 750mg to 1.5g three times a day•Amoxicillin 1g three times a day•Gentamicin 5-7mg/kg daily as one dose and then further doses as determined be serum Gentamicin concentrations (for organisms resistant to, or women allergic to, penicillins & cephalosporins)
UTI Management in Pregnancy
Duration of treatment:•Asymptomatic bacteriuria: 3Days•Acute cystitis: 7 days•Pyelonephritis: 10-14 daysProphylaxis of UTIs:•Cephalexin 250mg once daily•Amoxicillin 250mg once daily
UTI Management in Pregnancy
Obstetrics & Gynaecology: An Evidence-based Text for MRCOG, 3rd Edition, Chapter 13. 2016. (David M. Luesley & Mark D. Kilby)
Reference
XILCEF
Cefadroxil500mg Capsule/ 250mg Dispersible Tablet
250mg/5ml Dry Syrup (30ml Pack)
We DJPL cherish a sacred bond of Trust & Confidence with Gynae./Obs. Specialists of
Nepal.
Thank You so much for recognizingDeurali-Janta
For its quality services to the Nation.
Phr. Asad KamranTechnical Consultant, MPD
Deurali-Janta Pharmaceuticals Pvt. Ltd.