Out with the Old, In with the New: A Review of the Treatment of Intrapartum Infections

In 2019, a global meta-analysis demonstrated incidence of 3.9% for chorioamnionitis, 1.6% for endometritis, 1.2% for wound infection, 0.05% for sepsis, and 1.1% for maternal peripartum infection (Woodd et al. in PLOS Med 16(12):e1002984, 2019). Antimicrobial regimens for these infections are based on older microbiology profiles and may not account for changes in antimicrobial susceptibility data or the availability more modern antimicrobial therapies.

Recommendations for treatment of puerperal infection have not changed significantly in recent decades, despite the availability of new antimicrobial therapies with improved safety profiles.

A consideration should be given to monotherapy or two-drug regimens that have fewer toxicities than older therapeutics and require less monitoring. Obtaining appropriate microbiologic data and antimicrobial susceptibility data is critical to balance broad-spectrum coverage with the threat of antimicrobial resistance.