Antibiotic Use in Pregnancy

Clinical Guidelines for Antibiotic Prophylaxis

• The European Society of Cardiology recommends that women on anticoagulation for prosthetic valves should be switched from oral anticoagulants to low molecular weight heparin (LMWH) or unfractionated heparin from the 36th week of gestation 1
• The American College of Obstetricians and Gynecologists recommends GBS screening at 36 0/7 to 37 6/7 weeks gestation with vaginal-rectal culture 2
• For preterm labor or PPROM scenarios at <37 weeks, the American College of Obstetricians and Gynecologists recommends ampicillin 2 g IV once followed by 1 g IV every 6 hours for at least 48 hours for both latency and GBS prophylaxis 2
• The Centers for Disease Control and Prevention recommends penicillin G (5 million units IV initially, then 2.5-3.0 million units every 4 hours) as the preferred agent for intrapartum GBS prophylaxis due to its narrow spectrum and universal GBS susceptibility 3
• The Centers for Disease Control and Prevention recommends ampicillin (2 g IV initially, then 1 g every 4 hours) as an acceptable alternative for intrapartum GBS prophylaxis, but notes that it has broader spectrum activity 3
• The American College of Obstetricians and Gynecologists recommends cefazolin (2 g IV initially, then 1 g every 8 hours) as the preferred alternative for patients without high-risk allergy features 6
• The American College of Obstetricians and Gynecologists recommends clindamycin 900 mg IV every 8 hours (if susceptible) or vancomycin 1 g IV every 12 hours for high-risk allergy (anaphylaxis, angioedema, respiratory distress, urticaria) 4, 6

Important Considerations for Clinical Practice

• The American College of Obstetricians and Gynecologists notes that Augmentin is NOT listed as a recommended agent for routine GBS prophylaxis in CDC guidelines 3, 5
• The American College of Obstetricians and Gynecologists recommends ensuring at least 4 hours of IV antibiotics before delivery for adequate neonatal GBS protection 4
• The American College of Obstetricians and Gynecologists notes that treatment of the acute UTI does NOT eliminate colonization, and intrapartum prophylaxis is still required during labor for GBS bacteriuria detected during pregnancy 2