Sepsis resuscitation and supportive care
›Initial resuscitation
›Crystalloid fluids
›If hypotension or lactate elevation, initial bolus guided by perfusion
›Surviving Sepsis Campaign supports crystalloids as first-line resuscitation fluid
›Vasopressors
›Norepinephrine first-line for persistent hypotension
›Target MAP ≥ 65 mmHg
›Oxygen and ventilation
›Supplemental oxygen for hypoxemia
›Early airway control if deteriorating
›Antimicrobial strategy
›Timing principles
›If shock or high likelihood sepsis, antimicrobials immediately and ideally within 1 hour
›If possible sepsis without shock, antimicrobials within 3 hours if concern persists
›Surviving Sepsis Campaign antimicrobial timing recommendations
›De-escalation
›Narrowing based on cultures and clinical response
›Daily reassessment for de-escalation
Endometritis and genital tract infection
›Postpartum endometritis empiric IV therapy
›Preferred regimen
›Clindamycin IV
›900 mg every 8 hours
›Gentamicin IV
›5 mg/kg once daily
›Cochrane evidence supports clindamycin plus gentamicin as effective regimen
›WHO recommendation supports clindamycin plus gentamicin for postpartum endometritis
›Enterococcus coverage when indicated
›Ampicillin IV
›2 g every 6 hours
›Persistent fever at 48 to 72 hours
›High enterococcal risk
›Duration and endpoint
›Continue IV until afebrile for 24 to 48 hours
›Merck Manual describes IV therapy until afebrile for 48 hours
›Severe sepsis or toxic shock concern
›Broader empiric options per local antibiogram
›Piperacillin-tazobactam IV
›4.5 g every 6 to 8 hours
›Meropenem IV
›1 g every 8 hours
›Add clindamycin for toxin suppression when group A streptococcus suspected
›Early obstetric involvement
›Retained products evaluation
›Operative source control planning
Surgical site and soft tissue infection
›Superficial cellulitis post-cesarean
›Oral therapy when mild and no systemic signs
›Cephalexin PO
›500 mg every 6 hours
›If MRSA risk, add MRSA-active agent per local guidance
›IV therapy when systemic signs or rapid progression
›Cefazolin IV
›2 g every 8 hours
›If MRSA risk, vancomycin IV per weight-based dosing and trough targets
›Abscess or deep incisional infection
›Source control
›Incision and drainage
›Debridement for devitalized tissue
›Empiric coverage
›Broad gram-positive and anaerobic coverage based on depth and contamination
›Necrotizing soft tissue infection
›Immediate actions
›Emergent surgical debridement
›Broad-spectrum antibiotics immediately
›Empiric regimen example
›Piperacillin-tazobactam IV
›4.5 g every 6 hours
›Vancomycin IV
›Per weight-based dosing and renal function
›Clindamycin IV
›900 mg every 8 hours
›Supportive care
›ICU-level monitoring
›Aggressive resuscitation
Mastitis and breast abscess
›Lactational mastitis
›Continue breastfeeding or milk expression
›Prevent milk stasis
›Improve symptoms and reduce abscess risk
›Antibiotics when systemic symptoms or no improvement within 12 to 24 hours supportive measures
›Dicloxacillin PO
›500 mg every 6 hours
›Cephalexin PO
›500 mg every 6 hours
›If MRSA risk, MRSA-active agent per local guidance
›Breast abscess
›Drainage
›Ultrasound-guided aspiration
›Surgical drainage if large or recurrent
›Antibiotics
›Coverage for Staphylococcus aureus
›Adjust based on culture
›Cystitis
›Oral therapy options
›Nitrofurantoin PO
›100 mg twice daily for 5 days
›Fosfomycin PO
›3 g single dose
›Culture-directed adjustment
›Tailor to susceptibilities
›Pyelonephritis
›IV therapy
›Ceftriaxone IV
›1 to 2 g daily
›Broader coverage if severe sepsis or resistant risk
›Transition criteria
›Afebrile
›Improved symptoms
›Oral tolerance