Appropriateness of antibiotic use in the postpartum period.
OBJECTIVE
To determine the appropriateness of current postpartum antibiotic use in clinical practice.


METHODS
Medical records were reviewed for all patients delivering in a 3-month period who received postpartum antibiotics during the delivery hospitalization. Subjects were excluded if they received a single postpartum antibiotic dose as part of a mitral valve prolapse prophylaxis protocol, or if they received no more than one postpartum antibiotic dose for surgical prophylaxis. Characteristics of postpartum antibiotic use were abstracted.


RESULTS
Two hundred and eleven of 1537 (14%) delivering patients met the inclusion criteria. Seventy-four (35%) delivered vaginally and 137 (65%) delivered by Cesarean section. Postpartum fevers were found in 40 (54%) of vaginal delivery cases and 80 (58%) of women delivering by Cesarean section who received postpartum antibiotics (p = 0.54). For vaginal deliveries there were no differences in the duration of antibiotic use or number of antibiotic doses based on fever status. For Cesarean deliveries, a fever was associated with more antibiotic doses and a longer duration of antibiotic use. Physician justification for antibiotic use was documented in only 116 cases (55%).


CONCLUSIONS
The high proportion of women receiving postpartum antibiotics having no evidence for infection or documented indication for therapy suggests that antibiotics may not be appropriately used in the postpartum period.
Smulian
J C
JC
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UMDNJ-Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, NJ 08903-0591, USA. smuliajc@umdnj.edu
Potash
S K
SK
Lai
Y L
YL
Scorza
W E
WE
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D036861:Delivery, Obstetric; D004363:Drug Utilization; D005260:Female; D005334:Fever / Q000188:drug therapy*; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D009515:New Jersey; D017063:Outcome Assessment, Health Care; D049590:Postpartum Period; D010818:Practice Patterns, Physicians'; D011247:Pregnancy
D000900:Anti-Bacterial Agents