What is the treatment for chorioamnionitis?

From the Guidelines

Chorioamnionitis treatment requires prompt administration of broad-spectrum intravenous antibiotics and delivery of the fetus, with the recommended antibiotic regimen typically including ampicillin 2g IV every 6 hours plus gentamicin 1.5mg/kg IV every 8 hours, as supported by 1.

Key Considerations

• For patients with penicillin allergy, clindamycin 900mg IV every 8 hours can replace ampicillin, as noted in 1.
• If cesarean delivery is performed, adding clindamycin 900mg IV every 8 hours or metronidazole 500mg IV every 8 hours can provide anaerobic coverage, as suggested by 1.
• Antibiotics should be continued until the patient is afebrile for at least 24-48 hours, with most patients able to switch to oral antibiotics after clinical improvement, completing a total 7-10 day course, as recommended by 1.

Clinical Presentation and Diagnosis

• Chorioamnionitis results from ascending bacterial infection from the vagina into the uterus, causing inflammation of the fetal membranes, with classic signs including maternal fever, uterine tenderness, maternal or fetal tachycardia, and foul-smelling amniotic fluid, as described in 1.
• Close monitoring for complications like postpartum hemorrhage, endometritis, and wound infections is essential, as these occur more frequently in patients with chorioamnionitis, as noted in 1.

Management of Newborn Infants

• All newborn infants with signs suggestive of sepsis should have a full diagnostic evaluation, including a lumbar puncture if the infant is stable enough to undergo the procedure, as recommended by 1.
• Empirical antimicrobial therapy, typically intravenous ampicillin and gentamicin, should be initiated promptly in well-appearing newborn infants born to women who have a clinical diagnosis of chorioamnionitis, as suggested by 1.

From the Research

Treatment of Chorioamnionitis

• The first-line antimicrobial regimen for the treatment of clinical chorioamnionitis is ampicillin combined with gentamicin, which should be initiated during the intrapartum period 2.
• In the event of a cesarean delivery, patients should receive clindamycin at the time of umbilical cord clamping 2.
• The administration of additional antibiotic therapy does not appear to be necessary after vaginal or cesarean delivery 2.
• However, if postdelivery antibiotics are prescribed, there is support for the administration of an additional dose 2.

Antibiotic Regimens

• Daily gentamicin appears to be as effective as 8-hour gentamicin for the treatment of intrapartum chorioamnionitis 3.
• A meta-analysis of two studies found no clear differences in rates of neonatal sepsis, treatment failure, and postpartum hemorrhage when two different dosages/regimens of gentamicin were assessed 4.
• The use of antibiotics during the intrapartum period is superior to their use during the postpartum period in reducing the number of days of maternal and neonatal hospital stay 4.

Management and Outcomes

• Prompt diagnosis and timely treatment with broad-spectrum antibiotics can help avert the significant short-term and long-term consequences of chorioamnionitis 5.
• A shorter course of parenteral antibiotics without the addition of an oral antibiotic gives results comparable to the standard extended treatment regimens, but is advantageous with respect to cost, patient compliance, and hospital stay 6.
• Current evidence suggests that the administration of antenatal corticosteroids for fetal lung maturation and of magnesium sulfate for fetal neuroprotection to patients with clinical chorioamnionitis has an overall beneficial effect on the infant 2.