Comments from expert advisory group
- Consider sepsis and refer to hospital if suspected.
- The patient should be advised regarding correct hygiene of the perineum particularly following episiotomy. Hygiene advice should include daily showering of the perineum, frequent changing of sanitary pads, and hand washing before and after doing this. Advice should be provided on wound care, adequate hydration and the use of laxatives,
- If the perineal wound breaks down or there are ongoing healing concerns, refer the woman urgently to specialist maternity services (to be seen the same day in the case of a perineal wound breakdown).
Treatment
| Perineal Wound Infection Empiric Antibiotic Treatment Table | |||
| Drug | Dose | Duration | Notes |
| 1st choice option | |||
| Co-amoxiclav | 625mg every 8 hours | 5-7 days* | Avoid in penicillin allergy |
| 2nd choice option / Penicillin Allergy | |||
| Clindamycin | 300mg - 450mg every 6 hours | 5-7 days* | Caution: risk of C. difficile |
* Where Group A Strep is identified on culture: duration of therapy to be extended to 10 days. Antibiotics should be started for BOTH mother and neonates within 28 days of delivery as soon as possible, even if asymptomatic. For management of neonates, please refer to HPSC Guidance on Management of invasive and non-invasive Group A Streptococcal infection for mothers and neonates within 28 days of delivery where the document is available to download.
Patient Information
- An information sheet on ‘Antibiotics and breastfeeding' is available from the Breastfeeding Network UK
- Further information on Antibiotics and Breast-feeding can be found on the Mother to Baby website (USA) (Search or Use Browse by Medications category).
- HSE My Child is a useful resource for breastfeeding support and general guidance.
Safe Prescribing (visit the safe prescribing page)
- Doses are oral and for adults unless otherwise stated
- Dosing in children quick reference dosage/weight guide
- Penicillin allergy – tips on prescribing in penicillin allergy
- Renal impairment dosing table
- Safety in Pregnancy and Lactation
- Drug interactions tables. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
- Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).
Reviewed October 2024