The new study shows that a limited course of antibiotics was, overall, effective in treating 94% of patients with chorioamnionitis (95% CI, 92% and 96%). Only 1% of patients who delivered vaginally failed therapy, compared with 15% of patients who delivered by cesarean (P<.001). In the cesarean group, women who failed therapy were likely to 1) be obese or 2) have a relatively long duration of labor or ruptured membranes, or both. These patients may have benefitted from a more extended course of antibiotic therapy.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
Based on this investigation, I strongly recommend a limited course of antibiotic therapy (ampicillin plus gentamicin) for women with chorioamnionitis who deliver vaginally. Patients who have had a cesarean delivery—particularly those who are obese or have had an extended duration of labor, or both—should be treated with antibiotics until they have been afebrile and asymptomatic for 24 hours.
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