Gentamicin, an aminoglycoside with broad antimicrobial activity, is commonly used in both obstetrics and gynecology. Traditional dosing regimens for gentamicin have called for 3 times daily dosing, but recent insights into the pharmacodynamics of the drug have led to multiple studies of once-daily dosing regimens Some hospitals may standardize a 2 g cefazolin dose for all patients For non-obstetric patients, consensus opinion is 2 g cefazolin for patients ≥80 kg and 3 g cefazolin for patients ≥120 kg Data conflicting on 2 vs 3 g cefazolin dosing in obstetric population Increasing the dose to 2 g for ≥80 kg is recommende The vancomycin dosage for intrapartum GBS prophylaxis should be based on weight and baseline renal function (20 mg/kg intravenously every 8 hours, with a maximum of 2 g per single dose.) Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth Dose accuracy should be to the nearest 20mg of gentamicin or use table Prescribe in 'once only' section of medicine chart Inform midwife/nurse of prescription Administer dose in 100mls of 0.9% sodium chloride or 5% glucose over 1 hou ABSTRACT: Intraamniotic infection, also known as chorioamnionitis, is an infection with resultant inflammation of any combination of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. Intraamniotic infection is a common condition noted among preterm and term parturients. However, most cases of intraamniotic infection detected and managed by obstetrician-gynecologists or other.
. Alternative therapy includes 2 g of oral metronidazole in a.. For treatment of uncomplicated urogenital, rectal, or pharyngeal gonorrhea, CDC recommends a single 500 mg IM dose of ceftriaxone (Box). For persons weighing ≥150 kg (300 lbs), a single 1 g IM dose of ceftriaxone should be administered For treatment of severe Gram-negative infections, dose recommended for gentamicin or tobramycin is 7 mg/kg and dose recommended for amikacin is 20mg/kg Use Total Body Weight (TBW) if Total Body Weight is less than 1.2 x Ideal Body Weight (IBW) Use Adjusted Body Weight if Total Body Weight is ≥ 1.2 x Ideal Body Weight (IBW
Gentamicin loading dose IV or IM (2 mg/kg), followed by a maintenance dose (1.5 mg/kg) every 8 hours. Single daily dosing (3-5 mg/kg) can be substituted. Because of the pain associated with intravenous infusion, doxycycline should be administered orally when possible. Oral and IV administration of doxycycline provide similar bioavailability A comparison of clindamycin-gentamicin and penicillin-gentamicin in the treatment of post-cesarean section endomyometritis. Am J Obstet Gynecol 1979; 134:238. Faro S, Phillips LE, Baker JL, et al. Comparative efficacy and safety of mezlocillin, cefoxitin, and clindamycin plus gentamicin in postpartum endometritis Selection and dosing. Information is included regard-ing the approach to weight-based dosing in obese patients and the need for repeat doses during prolonged proce-dures.13-18 Obesity has been linked to an increased risk for SSI. The pharmacokinetics of drugs may be altered in obese patients, so dosage adjustments based on body weight ma consideration of the dose, route, duration and gestational timing of the treatment (1). Congenital defect can be defined as an anatomical anomaly but may also be a metabolic or functional (including mental retardation) anomaly caused by a genetic alteration or a physical, chemical or infectious agent reacting during prenatal life (2)
Gentamicin dosing was based on actual body weight. Women randomly assigned to daily gentamicin received 5 mg/kg intravenously (IV), followed by a normal saline placebo after 8 and 16 hours. Women randomly assigned to 8-hour gentamicin received a loading dose of 2 mg/kg IV, followed by 1.5 mg/kg after 8 and 16 hours ACOG recommends screening with urine culture at first prenatal visit (OB Intake) dose of Keflex 250 mg or Macrobid 50 mg. (Pregnant women with ampicillin/gentamicin complicated cases. Suppression therapy for remainder of pregnancy (same as described above) 2 Preface In Ireland, infection complicates about one in three pregnancies (Downey et al, personal communication). Some are diagnosed and treated in a hospital setting but as overnight bed stay
The American College of Obstetricians and Gynecologists (ACOG) published a committee opinion online July 25 and in the August issue of Obstetrics & Gynecology. cefazolin and gentamicin,. IV aminoglycosides are given slowly (30 minutes for divided daily dosing or 30 to 45 minutes for once/day dosing). In patients with normal renal function, once/day dosing is. Gentamicin or tobramycin: 5 mg/kg (7 mg/kg if patients are critically ill) every 24 hours. Amikacin: 15 mg/kg every 24 hours IV. Management: Intrapartum Intra-Amniotic Infection (pregnancy) Primary Protocol: No Penicillin Allergy. Ampicillin 2 g IV every 6 hours AND. Gentamycin 2 mg/kg IV load, then 1.5 mg/kg (Maximum 80-100 mg) every 8 hours. Adjust dosing per kinetics if >1-2 days use. Alternative: 5 mg/kg IV every 24 hours Vancomycin, 1 g IV over 1 hour; plus gentamicin, 1,5 mg/kg (not to exceed 80 mg) IV or IM 1 hour before procedure; may be repeated once 8 hours after the initial dose Amoxicillin, 3 g orally 1 hour before procedure; then 1.5 g 6 hours after the initial dose 'The standard regimen, although less convenient, is particularly recommended for.
Procedure Antibiotic Dose (single dose) Hysterectomy Cefazolin † 1 g or 2g ‡ IV Urogynecology procedures, Clindamycin § plus 600 mg IV including those involving mesh gentamicin or 1.5 mg/kg IV quinolone. ll. or 400 mg IV aztreonam 1 g IV Metronidazole § plus 500 mg IV gentamicin or 1.5 mg/kg IV quinolone. ll. 400 mg IV Laparoscopy None. . Normal dosing = 5 mg/kg. For patients with CrCl < 20 mL/min, consider 2 mg/kg. Round to the nearest 20 mg. Maximum dose is 700 mg. Preferred First Line Alternative if allergy to preferred antibiotic Type of Procedure Pre-OP Intra-op Re-dosing Pre-OP Intra-op Re-dosing In four studies comparing once-daily with thrice-daily dosing of gentamicin, there were fewer failures with once-daily dosing. There were more treatment failures (RR 1.94, 95% CI 1.38 to 2.72) and wound infections (RR 1.88, 95% CI 1.17 to 3.02) in those treated with a regimen with poor activity against penicillin-resistant anaerobic bacteria as. The recent ACOG practice bulletin is published in the June issue of Journal of Obstetrics and Gynecology and If there is a history of allergy to cephalosporins use Clindamycin 900 mg or metronidazole 500 mg PLUS Gentamicin 5mg/kg or aztreonam 2 g My Synthroid dosage was lowered. a friend advise me to contact a spiritualist who help with. • Gentamicin (dosing per pharmacy) • Duration of treatment: 10-14 days total Table 3. Catheter-Associated UTI • Treatment of asymptomatic bacteriuria is NOT recommended • Indwelling urinary catheters should be removed as soon as they are no longer required • If an indwelling catheter has been in place for >2 weeks at the onset o
allergic patients, weight-based gentamicin dosing (1.5 mg/kg) should provide adequate serum levels of the drug. 3Repeat the dose when needed Repeat the dose if surgery is long or involves a significant blood loss ACOG Committee on Practice Bulletins—Gynecology. ACOG practice bulletin No. 104: antibiotic prophy-laxis for gynecologic procedures The dosing interval for gentamicin, tobramycin, and amikacin is based on CrCl: CrCl ≥60 mL/min: every 24-hour interval. CrCl 40-59 mL/min: every 36-hour interval. CrCl 20-39 mL/min: every 48-hour interval. CrCl <20 mL/min: high-dose, extended-interval isn't recommended ACOG and AAP, continue to recommend screening of cefazolin (2g IV initial dose, then 1 g IV every 8 hours until delivery) is the antibiotic of choice. Cefazolin has a combination of ampicillin and gentamicin, but antibiotic resistance patterns at your hospital should be considered
Ampicillin 2gm IV q4-6h (or penicillin G 4 MU IV q4h)+ gentamicin 1.7mg/kg IV q8h x ≥ 3wks. Monitor renal function closely with gentamicin. May stop after 1-2 weeks if patient is significantly improved and/or renal function declines. AVOID dexamethasone: Associated with worse outcomes For true penicillin-allergic patients, weight-based gentamicin dosing (1.5 mg/kg) should provide adequate serum levels of the drug. 3. Repeat the dose when needed. Repeat the dose if surgery is long or involves a significant blood loss. ACOG Committee on Practice Bulletins—Gynecology Another option is gentamicin, 240-mg, single-intramuscular dose plus azithromycin 2-g, single-oral dose. When ceftriaxone is not available, ACOG recommends cefixime, 400-mg, single-oral dose plus azithromycin 1-g, single-oral dose. In pregnancy, ACOG recommends the same treatment, with no need for test-of-cure if treated properly
Gentamicin, loading dose IV or IM (2mg.kg) Followed by 1.5 mg/kg IV or IM g8h *The above regimen should be continued for at least 48 hours after the patient shows significant clinical improvement. After hospital discharge, doxycycline 100mg PO bid or clindamyci Introduction. Tubo-ovarian abscess (TOA) is a recognised and serious complication of untreated pelvic inflammatory disease (PID). It most commonly affects women of reproductive age and nearly 60% of women with TOA are nulliparous. 1 TOA is defined as an inflammatory mass involving the tube and/or ovary characterised by the presence of pus. The most common cause is ascending/upper genital tract. Synergy dosing for non-CNS gram-positive infections: IV, IM: 3 mg/kg/day in 1 to 3 divided doses in combination with a gram-positive active agent (AHA [Baddour 2015]; Leggett 2015; Olaison 2002). When divided doses are used, adjust gentamicin dose to achieve peak concentration of 3 to 4 mcg/mL and trough concentration <1 mcg/mL (AHA [Baddour. Dose. Hysterectomy. Urogynecology procedures, including those involving mesh. Cefazolin 1 (preferred) If PCN allergic: Clindamycin 2 plus. Gentamicin 3 (preferred for PCN allergic) OR. Metronidazole 2 plus. Gentamicin 3 (alternative for PCN allergic) Weight <120 kg: 2 g IV. Weight ≥120 kg: 3 g IV 600 mg IV. 5 mg/kg IV 4 500 mg IV. 5 mg/kg IV.
. All aminoglycosides are associated with the risk of ototoxicity beginning with the first dose. Tobramycin. An effective modality along when given IV or IM or given as a first dose in outpatient treatment Cefazolin dosing is 2g unless patient weight is > 120 kg. Gentamicin dosing is based on ideal body weight unless the patient is 20% above their IBW; then, an adjusted dosing weight is used: Dosing weight (kg) = IBW + [0.4 x (ABW - IBW)]. All antibiotics indicated are given intravenously, unless otherwise noted gentamicin for empiric treatment of neonates with suspected clinical sepsis; when referral is not possible, once daily gentamicin plus oral amoxicillin may be used. It is known, however, that in many countries, agents with a broader spectrum, such as -generation cephalosporinthird s, are commonly used to treat neonatal and infant sepsi
More recently, trials of treatment of chorioamnionitis have shifted towards testing the efficiency and safety of once-daily dosing of gentamicin. Gentamicin is a commonly used aminoglycoside in pregnancy for the treatment of Gram-negative bacteria, although there is reluctance by some practitioners to use it, given the known side effects of. Antibiotic regimens for postpartum endometritis. Intravenous clindamycin plus gentamicin is more effective than other antibiotics or combinations of antibiotics for treatment of womb infection after childbirth. Inflammation of the lining of the womb (endometritis) can be caused by vaginal bacteria entering the womb (uterus) during childbirth. Select a term to see related articles 2010 Antibacterial prophylaxis C-section Cefazolin Cephalosporin allergy Clindamycin Endometritis Gentamicin In Brief: Recommendation for Earlier Antibiotic Prophylaxis for Cesarean Delivery Issue 1348 October 4 page 80 penicillin allergy Sepsis Surgical prophylaxis . The American Congress of Obstetricians and Gynecologists (ACOG) has announced a new. Since maternal drug concentrations are a major determinant of fetal concentrations, standard dosing is preferred over extended-interval dosing because the latter regimen can result in supratherapeutic peak maternal serum aminoglycoside levels. 10 A recent study of extended-interval versus standard dosing of gentamicin in pregnant women at. BackgroundThe addition of azithromycin to standard regimens for antibiotic prophylaxis before cesarean delivery may further reduce the rate of postoperative infection. We evaluated the benefits and..
Clarification of statement regarding use of single dose azithromycin in emergency LSCS (pg 13) and addition of flowchart (pg 22) . Amalgamation of all variants of maternal sepsis . Inclusion of new teicoplanin and vancomycin guidelines . Vers ion 4.3 . February 2019 ; Dr Shabnam Iyer Christiana Ogunmoded ACOG Practice Bulletin #145, July 2014, reaffirmed 2017. ACOG A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis. prospective study comparing once-daily gentamicin versus thrice-daily gentamicin in the treatment of puerperal infection
25mg/5mL. Urinary Tract Infection. >1 month. 5-7 mg/kg/day PO divided q6hr for 7 days. UTI prophylaxis: 1-2 mg/kg PO qHS or 2 divided doses. >12 years. Macrocrystals (Macrodantin, Furadantin, and equivalents): 50-100 mg PO q6hr for 7 days or for 3 days after obtaining sterile urine IV: 2 g as a single dose at onset of labor or prelabor rupture of membranes, then 1 g every 4 hours until delivery (ACOG 2019). Urinary tract infection: Note: Uncomplicated urinary tract infection (UTI) has traditionally been defined as infection in an otherwise healthy nonpregnant female with a normal urinary tract; UTI in other patient. The AUA recommends a 2nd generation Cephalosporin, or alternatively Ampicillin-Sulbactam, Aminoglycoside + Metronidazole, or Clindamycin for all vaginal surgery [2 ••]. ACOG recommendations for vaginal surgery are Cefazolin with penicillin alternatives of either Metronidazole or Clindamycin plus either Gentamicin or Aztreonam [27 ••] 250 mg IM as a single dose plus azithromycin 1 g PO as a single dose. Ceftriaxone 250 mg IM as a single dose plus azithromycin 2 g PO as a single dose should be used in those with treatment failure after treatment with alternative regimen of cefixime and azithromycin.  For cases of documented or suspected cephalosporin-resistant N. gonorrhoeae, the World Health Organization (WHO.
ACOG updated their practice bulletin in September 2018 to suggest a dose of 3 g for women greater than 120 kg . In our study, conducted prior to the ACOG practice bulletin update in November 2017, we found that a minority of providers use 3 g in morbidly obese women CDC Recommendations Group B Streptococcus Prophylaxis. *If onset of labor or rupture of amniotic membranes occurs at 37 weeks' gestation and there is a significant risk for preterm delivery (as assessed by the clinician), a suggested algorithm for GBS prophylaxis is provided (Table 2). **If amnionitis is suspected, broad-spectrum antibiotic therapy that includes an agent known to be active.
Group B Strep in Pregnant Women - 2019 - ACOG. Group B Strep in Neonates - 2019 - AAP. Sexually Transmitted Diseases (STD) - 2015 - by CDC . Archived: Catheter-Associated Urinary Tract Infection (CAUTI) - 2010 (Archived) - by IDSA. Uncomplicated Urinary Tract Infection (UTI) and Pyelonephritis - 2011 (Archived) - by IDS Gentamicin 5mg./kg body weight/day in a single dose or in two divided doses. •Giving penicillin with gentamicin and metronidazole provides the broadest coverage. •Give IV fluids: 1 litre of 5% dextrose in saline or normal saline rapidly, followed by ˜000 cc every 24 hours. •Check vital signs and urinary output every 6 hours Administration of improper dose Overexposure or long exposure: Magnesium Toxicity How can you prevent this? Frequent evaluations of the patient for signs/symptoms of toxicity by the RN staff and Physicians or other providers Serial serum magnesium serum levels along with your basic lab
Note: dose adjustment may be required in renal failure. Antibiotic Dose Notes Nitrofurantoin 100mg orally, 12 hourly Try to avoid close to delivery if another option available as there is a small risk of haemolytic anaemia in the mother and fetus who are G6PD deficient Cefalexin 500mg orally,12 hourly Considered safe in pregnancy at an Ampicillin 100 mg/kg/dose IV q12h 2. Gentamicin 4 mg/kg/dose IV q24h Normal Lab Values (institution specific) 1. CRP < 0.5 mg/dL 2. CBC I:T ratio < 0.16 (some use 0.20) I:T ratio = immature / total neutrophils 3. Absolute neutrophil count within normal limit Today we dive into intraamniotic infection (IAI), more commonly known as chorioamnionitis or endometritis. CO 712 reviews a lot of the surprisingly limited evidence on the management of IAI, and the essentials you need to know for your labor floor and for CREOGs.. IAI is an important topic because of its morbidity. 2-5% of term deliveries are complicated by chorioamnionitis
Curettage. Figure 9.3 - Curettage. - With one hand, pull the Pozzi forceps attached to the cervix and keep traction in order to bring the cervix and the uterine body into the best possible alignment. - Choose the largest possible curette, since the smaller the curette, the greater the risk of trauma. The limit is the degree of dilation. Gentamicin 240mg IM once PLUS azithromycin 2g PO in a single dose a single dose. Patients with severe penicillin or cephalosporin allergy can be administered dual therapy with a 240-mg dose of IM gentamicin and 2-g oral azithromycin. Based on expert opinion, another alternative is a 2-g single dose of • ACOG Committee Opinion 645.
20. Russell GV, King C, May CG, et.al. Once daily high-dose gentamicin to prevent infection in open fractures of the tibial shaft: a preliminary investigation. South Med J 2001;94(12):1185-1191. 21. Sorger JL, Kirk PG, Ruhnke CJ, et.al. Once daily, high dose versus divided, low dose gentamicin for open fractures. Clin Orthop 1999;1(366):197-204 ACOG As understanding of these risks and the factors affecting them evolves, the result will be a reduction of medical practice variability, including delivery timing, medication use, and surveillance practices for expectant management. • A systematic evidence- and consensus-based approach will improve outcomes
ACOG practice bulletin 156: obesity in pregnancy. Efficacy of single dose of gentamicin in combination with metronidazole vs multiple doses for prevention of post-caesarean infection: study protocol for a randomized controlled trial Cesarean delivery (CD) is one of the most common procedures performed in the United States, accounting for 32% of all deliveries. Postpartum surgical site infection (SSI), wound infection and endometritis is a major cause of prolonged hospital stay and poses a burden to the health care system. SSIs complicate a significant number of patients who undergo CD - 2-7% will experience sound.
Ampicillin plus Gentamicin, TID dosing Ampicillin plus Gentamicin daily dosing plus Clindamycin Ampicillin plus Gentamicin TID dosing plus Clindamycin Other: What is your strategy for postpartum treatment after a vaginal delivery, in women diagnosed with intrapartum chorioamnionitis, in the absence of endometritis? No additional antibiotics. Additionally, medications that require weight-based considerations for dosing, such as aminoglycosides, macrolides, or vancomycin, might be challenging to implement. B-lactam antibiotics warrant consideration for increased dosing for particularly obese patients, which might be considered where obesity is a particular issue ( Pevzner et al., 2011 ) Infection of the operative site is the single most common complication associated with pelvic surgery. This chapter reviews the epidemiology, diagnosis, and management of the two most common postoperative infections - postcesarean endometritis and pelvic cellulitis after hysterectomy. It also considers several potentially serious and even. 3. Ampicillin 2 g IV every 6 hours for 48 hours and azithromycin 1 g orally in a single dose followed by amoxicillin 250 mg orally every 8 hours for 5 days to complete 7 days of coverage. 4. Patients allergic to penicillin: Azithromycin ONLY, 1 g orally in a single dose for PPROM plus GBS coverage as appropriate Upper UTI in Pregnancy Drug Dose Remarks Guideline IV Piperacillin/ Tazobactum OR IV Meropenam In mild Penicillin allergy IV Cefuroxime 4.5gm TDS x 48 Hrs 500mg QID x48hrs 1.5gm TDS x 48Hrs Add IV Gentamicin if no improvement in 24 hrs or patient in sepsis If patient improves Oral Cefalexin 500mg TDS x7 days NHS 2016 IV Piperacillin/ Tazobactum.
When given near delivery, the mean newborn gentamicin serum levels after single and divided dosing were 1.94 and 0.98 mcg/ml, respectively. Therefore, if possible, divided dosing for gentamicin is preferred. A drug interaction between gentamicin and magnesium sulfate has also been reported of 0.25, 0.5, and 1.0 mg of estradiol for dosing flexibility.7 On August 9, 2007, the FDA announced its approval of a metered-dose estradiol transdermal spray (EvaMist), which contains 1.53 mg of estradiol per spray, and noted that, based on clinical re-sponse, the dose may be increased to 2 to 3 sprays per day. Harbarth, S. (2018). Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association, 319(17), 1781-1789 Aminoglycoside Dosing - Hull Sarubbi Nomogram Aminoglycosides Dosing Anion Gap (Serum) Anion Gap (Urine) APGAR Asthma Management Calculator: 12 Years of Age and Older. Clostridium difficile diarrhea. 125 mg orally 4 times daily for 10 days (FDA dosage)   Initial episode, severe or nonsevere, 125 mg orally 4 times daily for 10 days (guideline dosage)  Fulminant disease, 500 mg orally/NG tube 4 times daily plus IV metronidazole 500 mg every 8 hours; if complete ileus, consider adding vancomycin retention enema (500 mg in 100 mL NS) rectally every 6.
After 3 days of treatment with gentamicin, the minimum inhibitory concentration (MIC) changed from less than 1 mg/L to more than 16 mg/L. It appears that suboptimal gentamicin dosing led to the development of gentamicin resistance. As the patient was not improving clinically, the antibiotics were changed once the gentamicin resistance was. Doxycycline dosing for acne for crestor and neuropathy The surgeon must stand high enough for optimal placement of instruments or robotic techniques. P.243 acog committee on hospital transfusion practice of postprocedure intrauterine balloon stenting: A randomized controlled trial. Thus, streptomycin or gentamicin added to equivalent. MTHFR is a gene. We all carry two copies of MTHFR. MTHFR tells our body how to create an enzyme involved in breaking down the amino acid homocysteine.    As is true for any gene, the DNA code of the MTHFR gene can vary. When we identify a part of the sequence that varies, we call it a variant If you have lichen sclerosus on or around your genitals or anus, or have a more advanced case on other parts of your body, your doctor will recommend treatment. Treatment helps reduce itching, improve your skin's appearance and decrease further scarring. Recurrence is common. Rarely, lichen sclerosus gets better on its own Escherichia coli isolates demonstrated high rates of resistance to ampicillin (70.3%) and gentamicin (33.3%), but low rates of resistance to co-amoxiclav (3.6%) and intravenous cefuroxime (14.0%). Notably, our laboratory did not routinely perform sensitivity testing of E coli to erythromycin because of its presumed resistance to the antibiotic