Medication Summary
The goals of pharmacotherapy are to prevent complications and infections and reduce morbidity.
Antibiotics, Other
Class Summary
Routine use of prophylactic antibiotics is not necessary. However, in the case of third or fourth-degree lacerations, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends prophylactic broad-spectrum antibiotics to reduce the incidence of infection and dehiscence.
Cephalexin (Keflex)
Cephalexin is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms. Cephalexin's primary activity is against skin flora; the drug is used for skin infections or prophylaxis in minor procedures.
Cefazolin
Cefazolin is a first-generation semisynthetic cephalosporin that by binding to 1 or more penicillin-binding proteins arrests bacterial cell wall synthesis and inhibits bacterial replication. It has a poor capacity to cross blood-brain barrier. It is primarily active against skin flora, including Staphylococcus aureus. Regimens for IV and IM dosing are similar.
Amoxicillin and clavulanate (Augmentin, Augmentin XR, Amoclan)
Amoxicillin inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins. Addition of clavulanate inhibits beta-lactamase producing bacteria.
It is a good alternative antibiotic for patients allergic or intolerant to the macrolide class. It is usually well tolerated and provides good coverage to most infectious agents. Not effective against Mycoplasma and Legionella species.
Ampicillin and sulbactam (Unasyn)
This is a drug combination of beta-lactamase inhibitor with ampicillin. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. It is an alternative to amoxicillin when the patient is unable to take medication PO. It covers skin, enteric flora, and anaerobes. It is not ideal for nosocomial pathogens.
-
Anatomy of the female perineum, with potential sites for episiotomy incision indicated. Image courtesy of Wikimedia Commons (Blausen.com staff in Blausen gallery 2014. Wikiuniversity Journal of Medicine. Available at: https://commons.wikimedia.org/wiki/File:Blausen_0355_Episiotomy.png).
-
Crowning of an infant's head, with potential sites for episiotomy incision indicated. Image courtesy of Wikimedia Commons (Blausen.com staff in Blausen gallery 2014. Wikiuniversity Journal of Medicine. Available at: https://commons.wikimedia.org/wiki/File:Blausen_0294_Delivery_Crowning.png).
-
Incisions for mediolateral and midline (median) episiotomy. Image courtesy of Wikimedia Commons (Available at: https://commons.wikimedia.org/wiki/File:Medio-lateral-episiotomy.gif).
