Chorioamnionitis medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Chorioamnionitis}} | {{Chorioamnionitis}} | ||
{{CMG}} | {{CMG}} ; {{AE}} {{Adnan Ezici}} | ||
=Overview= | =Overview= | ||
Antimicrobial therapy is indicated among patients with chorioamnionitis. The preferred regimen is a combination of [[ampicillin]] and [[gentamicin]]. Supportive therapy, such as antipyretics, may also be used. | Antimicrobial therapy is indicated among patients with chorioamnionitis. The preferred regimen is a combination of [[ampicillin]] and [[gentamicin]]. Supportive therapy, such as antipyretics, may also be used. | ||
==Medical Therapy== | ==Medical Therapy== | ||
Medical therapy for chorioamnionitis includes antimicrobial therapy and | Medical therapy for chorioamnionitis includes antimicrobial therapy and supportive therapy: | ||
*1. '''Chorioamnionitis'''<ref name="pmid17400872">{{cite journal| author=ACOG Committee on Practice Bulletins-Obstetrics| title=ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. | journal=Obstet Gynecol | year= 2007 | volume= 109 | issue= 4 | pages= 1007-19 | pmid=17400872 | doi=10.1097/01.AOG.0000263888.69178.1f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17400872 }} </ref><ref name="pmid20569811">{{cite journal| author=Tita AT, Andrews WW| title=Diagnosis and management of clinical chorioamnionitis. | journal=Clin Perinatol | year= 2010 | volume= 37 | issue= 2 | pages= 339-54 | pmid=20569811 | doi=10.1016/j.clp.2010.02.003 | pmc=PMC3008318 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20569811 }} </ref> | *1. '''Chorioamnionitis'''<ref name="pmid17400872">{{cite journal| author=ACOG Committee on Practice Bulletins-Obstetrics| title=ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. | journal=Obstet Gynecol | year= 2007 | volume= 109 | issue= 4 | pages= 1007-19 | pmid=17400872 | doi=10.1097/01.AOG.0000263888.69178.1f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17400872 }} </ref><ref name="pmid20569811">{{cite journal| author=Tita AT, Andrews WW| title=Diagnosis and management of clinical chorioamnionitis. | journal=Clin Perinatol | year= 2010 | volume= 37 | issue= 2 | pages= 339-54 | pmid=20569811 | doi=10.1016/j.clp.2010.02.003 | pmc=PMC3008318 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20569811 }} </ref><ref name="pmid33007269">{{cite journal |vauthors=Conde-Agudelo A, Romero R, Jung EJ, Garcia Sánchez ÁJ |title=Management of clinical chorioamnionitis: an evidence-based approach |journal=Am J Obstet Gynecol |volume=223 |issue=6 |pages=848–869 |date=December 2020 |pmid=33007269 |doi=10.1016/j.ajog.2020.09.044 |url=}}</ref> | ||
:* Preferred regimen: [[Ampicillin]] 2 g IV q6h {{and}} ([[Gentamicin]] 1.5 mg/kg IV q8h {{or}} [[Gentamicin]] 5 mg/kg IV q24h) until delivery | :*Preferred regimen: [[Ampicillin]] 2 g IV q6h {{and}} ([[Gentamicin]] 1.5- mg/kg IV q8h {{or}} [[Gentamicin]] 5 mg/kg IV q24h) until the delivery or [[Ampicillin-Sulbactam|Ampicillin/Sulbactam]] 3 g IV q6h until the delivery | ||
:*Alternative regimen, penicillin-allergic: [[Clindamycin]] 900 mg IV q8h {{ | :*Alternative regimen, penicillin-allergic: [[Clindamycin]] 900 mg IV q8h {{or}} [[Vancomycin]] 1 g IV q12h {{or}} [[Erythromycin]] (500 mg-1 g) IV q6h until the delivery | ||
:* Note (1): For patients with cesarean section | :* Note (1): For patients with cesarean section, add [[Clindamycin]] 900 mg IV in a single dose only after clamping the umbilical cord ([[Metronidazole]] 500 mg IV is an alternative). | ||
:* Note (2): For patients with cesarean section who are penicillin-allergic, [[Metronidazole]] should | :* Note (2): For patients with cesarean section who are penicillin-allergic, [[Metronidazole]] should be avoided post-partum. | ||
*2. '''Supportive measures'''<ref name="pmid17400872">{{cite journal| author=ACOG Committee on Practice Bulletins-Obstetrics| title=ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. | journal=Obstet Gynecol | year= 2007 | volume= 109 | issue= 4 | pages= 1007-19 | pmid=17400872 | doi=10.1097/01.AOG.0000263888.69178.1f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17400872 }} </ref><ref name="pmid33007269">{{cite journal |vauthors=Conde-Agudelo A, Romero R, Jung EJ, Garcia Sánchez ÁJ |title=Management of clinical chorioamnionitis: an evidence-based approach |journal=Am J Obstet Gynecol |volume=223 |issue=6 |pages=848–869 |date=December 2020 |pmid=33007269 |doi=10.1016/j.ajog.2020.09.044 |url=}}</ref> | |||
*2. '''Supportive measures'''<ref name="pmid17400872">{{cite journal| author=ACOG Committee on Practice Bulletins-Obstetrics| title=ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. | journal=Obstet Gynecol | year= 2007 | volume= 109 | issue= 4 | pages= 1007-19 | pmid=17400872 | doi=10.1097/01.AOG.0000263888.69178.1f | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17400872 }} </ref> | :* Preferred regimen: [[Acetaminophen]] (325–650 mg) q(4-6)h PO (maximum, 4 g per day) as an antipyretic. | ||
:* Preferred regimen: | :* Note (1): At least single dose of antenatal [[corticosteroids]] might decreased the neonatal mortality without causing an adverse outcomes (execarbation of infection or [[neonatal sepsis]]), therefore, it might be beneficial for women with clinical chorioamnionitis (gestational age between 24 0/7 and 33 6/7). | ||
:* Note (2): While [[magnesium sulfate]] is a neuroprotective and decreases the risk of [[cerebral palsy]], it should be recommended for women with clinical chorioamnionitis (gestational age between 24 0/7 and 33 6/7). | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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{{WS}} | {{WS}} | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Obstetrics]] | [[Category:Obstetrics]] | ||
[[Category:Inflammations]] | [[Category:Inflammations]] | ||
[[Category:Bacterial diseases]] | [[Category:Bacterial diseases]] | ||
[[Category:NeedsEnglishReview]] | |||
Latest revision as of 20:09, 12 June 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Overview
Antimicrobial therapy is indicated among patients with chorioamnionitis. The preferred regimen is a combination of ampicillin and gentamicin. Supportive therapy, such as antipyretics, may also be used.
Medical Therapy
Medical therapy for chorioamnionitis includes antimicrobial therapy and supportive therapy:
- Preferred regimen: Ampicillin 2 g IV q6h AND (Gentamicin 1.5- mg/kg IV q8h OR Gentamicin 5 mg/kg IV q24h) until the delivery or Ampicillin/Sulbactam 3 g IV q6h until the delivery
- Alternative regimen, penicillin-allergic: Clindamycin 900 mg IV q8h OR Vancomycin 1 g IV q12h OR Erythromycin (500 mg-1 g) IV q6h until the delivery
- Note (1): For patients with cesarean section, add Clindamycin 900 mg IV in a single dose only after clamping the umbilical cord (Metronidazole 500 mg IV is an alternative).
- Note (2): For patients with cesarean section who are penicillin-allergic, Metronidazole should be avoided post-partum.
- Preferred regimen: Acetaminophen (325–650 mg) q(4-6)h PO (maximum, 4 g per day) as an antipyretic.
- Note (1): At least single dose of antenatal corticosteroids might decreased the neonatal mortality without causing an adverse outcomes (execarbation of infection or neonatal sepsis), therefore, it might be beneficial for women with clinical chorioamnionitis (gestational age between 24 0/7 and 33 6/7).
- Note (2): While magnesium sulfate is a neuroprotective and decreases the risk of cerebral palsy, it should be recommended for women with clinical chorioamnionitis (gestational age between 24 0/7 and 33 6/7).
References
- ↑ 1.0 1.1 ACOG Committee on Practice Bulletins-Obstetrics (2007). "ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists". Obstet Gynecol. 109 (4): 1007–19. doi:10.1097/01.AOG.0000263888.69178.1f. PMID 17400872.
- ↑ Tita AT, Andrews WW (2010). "Diagnosis and management of clinical chorioamnionitis". Clin Perinatol. 37 (2): 339–54. doi:10.1016/j.clp.2010.02.003. PMC 3008318. PMID 20569811.
- ↑ 3.0 3.1 Conde-Agudelo A, Romero R, Jung EJ, Garcia Sánchez ÁJ (December 2020). "Management of clinical chorioamnionitis: an evidence-based approach". Am J Obstet Gynecol. 223 (6): 848–869. doi:10.1016/j.ajog.2020.09.044. PMID 33007269 Check
|pmid=value (help).