Version July 2025
| Antibiotic | Dose | Comments |
| Preferred regimen | ||
| Ampicillin | 2 g IV every 6 hours | In patients who will undergo a cesarean birth, add
Some clinicians add a single dose of azithromycin 500 mg IV in these patients to cover Ureaplasma and Mycoplasma species Some clinicians add metronidazole or clindamycin in all patients with chorioamnionitis, regardless of route of delivery |
| plus | ||
| Gentamicin* | 5 mg/kg IV once daily | |
| Alternative regimens | ||
| Vancomycin¶ | 15 to 20 mg/kg IV every 8 to 12 hours based on actual body weight, rounded to the nearest 250 mg increment | Preferred regimen for patients allergic to penicillins and cephalosporins |
| plus | ||
| Gentamicin* | 5 mg/kg IV once daily | |
| ClindamycinΔ | 900 mg IV every 8 hours | |
| plus | ||
| Gentamicin* | 5 mg/kg IV once daily | |
| Ampicillin | 2 g IV every 6 hours | |
| plus | ||
| Gentamicin* | 1.5 mg/kg IV every 8 hours◊ | |
| Ampicillin-sulbactam | 3 g IV every 6 hours | |
| Cefoxitin | 2 g IV every 8 hours | |
| Cefotetan | 2 g IV every 12 hours | |
| Ceftriaxone | 2 g IV every 24 hours | |
| plus | ||
| Metronidazole | 500 mg IV every 8 hours | |
| Piperacillin-tazobactam | 3.375 g IV every 6 hours or 4.5 g IV every 8 hours | |
| Ertapenem | 1 g IV every 24 hours | |
These doses are for patients with normal kidney function; dose adjustments may be warranted for patients with kidney impairment. Refer to drug monographs included within UpToDate.
Antibiotics are discontinued postpartum. The duration of dosing after delivery depends on factors such as route of delivery and clinical findings (eg, fever). Refer to UpToDate content on chorioamnionitis for more information.
* Routine monitoring of gentamicin levels is unnecessary for patients who are healthy except for chorioamnionitis. Dose is based on actual body weight; however, for patients with actual body weight more than 1.2 times greater than their ideal body weight, use adjusted body weight. A calculator for ideal body weight and adjusted body weight is available in UpToDate.
¶ For patients who require vancomycin for more than 2 to 3 days, monitoring is required. Refer to UpToDate content on vancomycin dosing and monitoring.
Δ If Group B streptococcus coverage is needed, clindamycin should only be used if clindamycin-inducible resistance testing is negative.
◊ Some centers administer a gentamicin load (eg, 2 mg/kg) with thrice-daily dosing, but objective data to support its superiority are lacking.
