Ceftriaxone 500mg IM in a single dose

(if BW>150kg, 1g IM STAT) 

PLUS

Metronidazole 400mg PO q12h for 14 days

PLUS

Doxycycline 100mg PO q12h for 14 days

If cephalosporin allergy and low risk for gonorrhoea:

Levofloxacin 500mg PO q24h for 14 days

PLUS 

Metronidazole 400mg PO q12h for 14 days

Sexual partner(s) within 60 days should be examined, investigated and treated epidemiologically for chlamydia and gonorrhoea, regardless of PID aetiology or pathogen isolated. 

Abstain from sex until the patient and partner(s) have completed treatment and symptoms are resolved.

Ceftriaxone 2g IV q24h 

PLUS

Doxycycline 100mg PO q12h 

PLUS

Metronidazole 400mg PO or 500mg IV q12h

Ampicillin/sulbactam 3g IV q6h

PLUS
Doxycycline 100mg PO q12h 

OR

Clindamycin 900mg IV q8h

PLUS

Gentamicin 3-5mg/kg IV q24h

*Oral step-down therapy:

Clindamycin 450mg PO q6h or 600mg PO q8h

OR

Doxycycline 100mg PO q12h 

PLUS

Metronidazole 400mg PO q12h

Duration: 14 days

Tubo-ovarian abscess: Surgical intervention for source control may be required.

May need to consider tuberculosis if not responding to standard treatment.

*Patients with clinical improvement after 24-48 hours can be transitioned to oral therapy to complete the 14 days of treatment.

Amoxicillin/clavulanate 1.2g IV q8h

OR

Ampicillin/sulbactam 3g IV q6h

Cefotaxime 1g IV q8h

PLUS

Metronidazole 500mg IV q8h

PLUS

Gentamicin 5mg/kg IV x 1 dose 

OR

Clindamycin 900mg IV q8h

PLUS

*Gentamicin 5mg/kg q24h 

IV treatment is typically continued until the patient is clinically improved (no fundal tenderness) and afebrile for 24 - 48 hours. 

If an oral antibiotic regimen is administered, duration: 14 days.

*TDM for gentamicin is required

Ampicillin/sulbactam 3g IV q6h

PLUS

Doxycycline 100mg PO q12h

Ampicillin 2g IV q4-6h

PLUS

Metronidazole 500mg IV q8h 

PLUS

Gentamicin 5mg/kg IV q24h

OR

Clindamycin 900mg IV q8h

PLUS

*Gentamicin 5mg/kg IV q24h

Duration: 10-14 days 

Intravenous antibiotics are administered until the patient has improved and afebrile for 48 hours, then are typically followed by oral antibiotics. 

*TDM for gentamicin is required

Ampicillin/sulbactam 3g IV q6h

(Regardless of the mode of delivery)

Ampicillin 2g IV q6h 

PLUS

Gentamicin 5mg/kg IV q24h

If the patient is undergoing a cesarean delivery:

Ampicillin 2g IV q6h 

PLUS

Gentamicin 5mg/kg IV q24h

PLUS 

Metronidazole 500mg IV q8h

Mild antibiotic allergy: 

Cefazolin 2g IV q8h 

PLUS

Gentamicin 5mg/kg IV q24h

Severe antibiotic allergy: 

Clindamycin 900mg IV q8h

Antibiotic regimen is continued postpartum until the patient is afebrile and asymptomatic for at least 48 hours.

There is no evidence that continuation with oral antibiotic are beneficial after discontinuation of parenteral therapy.

Benzylpenicillin 5MU IV initial dose, then 2.5–3MU IV q4h until delivery

Ampicillin 2g IV initial dose, then 1g IV q4h until delivery

Mild antibiotic allergy:

Cefazolin 2g IV initial dose, then 1g q8h until delivery

OR

Cefuroxime 1.5g IV STAT and 750mg IV q8h until delivery

Severe antibiotic allergy:

Vancomycin 15-20mg/kg IV q8-12h until delivery

OR

Clindamycin 900mg IV q8h until delivery

Prophylaxis begins at hospital admission for labour or rupture of membrane and continued every four hours until the infant is delivered.

Treatment is not indicated if Caesarean section is performed before onset of labour with intact membrane (please use standard surgical prophylaxis).

Antenatal treatment is not recommended for GBS cultured from a vaginal or rectal swab.

Erythromycin ethylsuccinate 400mg PO q6h or 800mg PO q12h for 7-10 days

--

--

Ampicillin 2g IV q6h for 48 hours 

PLUS

*Azithromycin 1g PO STAT upon admission

Followed by:

Amoxicillin 500mg PO q8h for an additional 5-7 days or until delivery whichever comes first

--

*To cover for Ureaplasmas – important cause of chorioamnionitis & Chlamydia 

Cloxacillin 500mg PO q6h 

Cephalexin 500mg PO q6h

Duration: 5-7 days. If poor response, may consider extending to 10-14 days. 

Cloxacillin 2g IV q4-6h

Cefazolin 1-2g IV q8h 

Duration: 5-7 days. If poor response, may consider extending to 10-14 days. 

Cloxacillin 500mg PO q6h for 5-7 days

Antibiotic allergy:

Erythromycin ethylsuccinate 400mg PO q6h or 800mg PO q12h for 5-7 days

Appropriate dressing is the mainstay of treatment.

Cloxacillin 2g IV q6h

OR

Cefazolin 1-2g IV q8h 

Risk of gram negative or anaerobic infection (e.g. diabetes):

Amoxicillin/clavulanate 1.2g IV q8h

OR

Ampicillin/sulbactam 3g IV q6h

Duration: 10-14 days but shorter duration (5-7 days) can be considered if adequate source control and local wound management result in clinical improvement.

Amoxicillin/clavulanate 625mg PO q8h 

Trimethoprim/sulfamethoxazole 160mg/800mg PO q12h 

Duration: 5-7 days

If the patient has risk factors for sexually transmitted infections (STIs), appropriate investigations should be performed, and empirical treatment initiated as outlined in the STI chapter.

Surgical management is recommended if the abscess does not drain spontaneously.