Limited Postpartum Versus 24-Hour Antibiotic Dosing Regimens Following Intrapartum Chorioamnionitis [11A

Abstract

INTRODUCTION: The objective of this study was to determine if limited postpartum dosing versus (LPD) 24-hour dosing treatment regimens for endometritis prophylaxis following deliveries complicated by intrapartum chorioamnionitis (IC) provides greater effectiveness. METHODS: We conducted a prospective observational cohort study and followed all women receiving treatment for IC. All patients diagnosed with IC received IV gentamicin and IV ampicillin. Those who required a cesarean delivery additionally received IV clindamycin. Those in the LPD group received an additional dose of ampicillin (and clindamycin if cesarean delivery) while the 24-hour dosing group were continued on the scheduled antibiotics for 24 hours. Appropriate IRB approval was obtained. The primary outcome was treatment failure defined by persistent fever and fundal tenderness requiring continuation of antibiotics and ascribing a diagnosis of postpartum endometritis. RESULTS: The study included 206 patients, where 120 patients received 24-hour dosing of antibiotics postpartum and 86 received LPD. Baseline characteristics were not significantly different. Rates of endometritis were noted to be less in the 24-hour dosing group (15.8% versus 29.1%, P=.022) with a 46% decreased risk of developing endometritis (RR 0.54, 95% CI 0.3–0.99, P=.46). After adjusting for perceived confounders, this decreased risk was no longer statistically significant. CONCLUSION: In this prospective study, either dosing strategy appears to have equivalent efficacy of endometritis prophylaxis after adjusted analysis. Given the lack of superiority of either regimen, each dosing approach remains reasonable with the LTD favored to limit overuse of antibiotics and combat resistance.