What antibiotics should be continued at home after discharge?

Antibiotic Prescribing at Hospital Discharge for IUFD

For patients with intrauterine fetal demise (IUFD) being discharged home, antibiotics should generally be discontinued if the patient is clinically well, afebrile, and all cultures are negative at 24-36 hours, unless a specific infection requiring ongoing treatment has been identified.

Decision Algorithm for Antibiotic Continuation

Discontinue Antibiotics When ALL of the Following Are Met:

• All bacterial cultures (blood, urine, endometrial) are negative at 24-36 hours 1
• Patient is clinically well or improving (afebrile, normal vital signs, no signs of sepsis) 1
• No documented infection requiring treatment (such as chorioamnionitis, endometritis, or urinary tract infection) 1

Continue Antibiotics at Discharge When:

• Positive urine culture (UTI) is documented - Switch from parenteral to oral antibiotics when blood and other cultures are negative at 24-36 hours and patient is clinically stable 1
• Documented endometritis or chorioamnionitis - Complete the appropriate treatment course based on the specific pathogen and clinical response 1
• Positive blood cultures - Continue targeted antimicrobial therapy for the duration appropriate to the organism identified 1

Specific Antibiotic Selection for Home Therapy

For Urinary Tract Infection (Most Common Indication):

• First-line oral options: Amoxicillin 500-1000 mg every 8 hours for 5-7 days 2
• For beta-lactamase producing organisms: Amoxicillin-clavulanate 2
• Penicillin-allergic patients: Oral cephalosporins (non-anaphylactic allergy) or macrolides 2
• Treatment failures: Consider fluoroquinolones, though these should be reserved for complicated cases 2

For Documented Endometritis/Chorioamnionitis:

• Continue targeted therapy based on culture results for the full recommended duration (typically 7-10 days total) 1
• Transition to oral antibiotics when clinically stable, afebrile for 24-48 hours, and able to tolerate oral intake 3, 4

Duration of Therapy Considerations

The median duration of antibiotics prescribed at discharge is typically 5-7 days, though this should be tailored to the specific infection 3, 5. Research shows that approximately 60% of total antibiotic treatment occurs after hospital discharge, with median outpatient durations of 7 days 5.

For UTI specifically: 5-7 days of oral therapy is appropriate once switched from parenteral antibiotics 1, 2

Critical Pitfalls to Avoid

• Do not continue empiric broad-spectrum antibiotics (such as fluoroquinolones or amoxicillin-clavulanate) when cultures are negative and the patient is clinically well 3
• Avoid unnecessarily prolonged durations - Many discharge prescriptions exceed guideline-recommended durations, contributing to antimicrobial resistance 5
• Do not prescribe antibiotics "just in case" when there is no documented infection - this increases risk of Clostridioides difficile infection (adjusted OR 1.7) and emergency department visits (adjusted OR 1.2) 6
• Ensure follow-up is arranged within 24-36 hours if antibiotics are discontinued, so clinical deterioration can be detected early 1

Monitoring Requirements

• Patients discharged on antibiotics should have follow-up arranged to assess clinical response and ensure completion of therapy 1
• Instruct patients to return immediately if fever recurs, bleeding increases, or other concerning symptoms develop 1
• Consider repeat cultures if clinical improvement does not occur as expected, though this may risk identifying contaminants 1

Special Circumstances

If patient had positive blood cultures during hospitalization: Even if discharged with negative repeat cultures, ensure targeted antibiotic therapy is continued for the full recommended duration based on the organism (typically 7-14 days depending on pathogen) 1

If switching from IV to oral therapy: This transition is appropriate when the patient is clinically stable, afebrile, tolerating oral intake, and cultures show susceptible organisms 1, 4