Perineal wound infection - Antibiotic Prescribing

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)


Reviewed October 2024

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