gynae/ obstetrics & antibiotics

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.