Medication Summary
The goals of pharmacotherapy are to eradicate the infection, reduce morbidity, and prevent complications. Aggressive antimicrobial therapy prevents death by eliminating all septic sources during the early stages of the disease.
Although serious infections with clostridial organisms have been reported following medication abortions, such infections are rare. Thus, the American College of Obstetricians and Gynecologists does not recommend the routine use of prophylactic antibiotics for medication abortion. [19]
Antibiotics
Class Summary
Immediately administer broad-spectrum antibiotics to patients with severe postabortion infection.
Cefoxitin (Mefoxin)
Indicated for infections caused by susceptible gram-positive cocci and gram-negative bacilli. Many infections caused by gram-negative bacteria resistant to some cephalosporins and penicillins respond to cefoxitin.
Doxycycline (Bio-Tab, Doryx, Vibramycin)
Treats infections caused by susceptible gram-negative and gram-positive organisms, in addition to infections caused by susceptible Rickettsia, Chlamydia, and Mycoplasma species.
Gentamicin sulfate (Garamycin, Gentacidin)
Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and an agent that covers anaerobes. Not the DOC. Consider if penicillins (see note above) or other less toxic drugs are contraindicated, when clinically indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms. Dosing regimens are numerous; adjust dose based on CrCl and changes in volume of distribution. May be administered IV/IM.
Ticarcillin and clavulanate potassium (Timentin)
Presumptive therapy prior to identification of organism. Inhibits biosynthesis of cell wall mucopeptide; effective during stage of active growth.
Ampicillin and sulbactam sodium (Unasyn)
Drug combination of beta-lactamase inhibitor with ampicillin. Covers skin, enteric flora, and anaerobes. Not ideal for nosocomial pathogens.
Imipenem and cilastatin sodium (Primaxin)
Treats multiple-organism infections for which other agents lack wide-spectrum coverage or are contraindicated due to potential toxicity.
Piperacillin and tazobactam sodium (Zosyn)
Treats septicemia caused by susceptible organisms.
Clindamycin (Cleocin)
Useful as treatment against aerobic streptococci and most staphylococci. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.
Cefotaxime (Claforan)
Treats septicemia and gynecologic infections caused by susceptible organisms. Arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth.
Vancomycin HCL (Vancocin, Vancoled)
Potent antibiotic directed against gram-positive organisms and active against enterococcal species. Useful in the treatment of septicemia and skin structure infections. Indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or who have infections with resistant staphylococci. To avoid toxicity, current recommendation is to assay only vancomycin trough levels after the third dose, drawn 0.5 h before next dosing. Doses and dosing intervals may be adjusted based on CrCl.
Ceftriaxone (Rocephin)
Third-generation cephalosporin with broad-spectrum gram-negative activity; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins.
Synthetic posterior pituitary hormones
Class Summary
When D&C is not immediately available, these hormones are used to induce contractions to help evacuate retained products of conception from the uterus.
Oxytocin (Pitocin, Syntocinon)
Produces rhythmic uterine contractions and can stimulate the gravid uterus, as well as vasopressive and antidiuretic effects. Also can control postpartum bleeding or hemorrhage.
Ergot alkaloids
Class Summary
Ergot derivatives are used for oxytocic effects on uterine muscle. These agents prevent postabortion uterine atony and hemorrhage.
Ergonovine (Ergotrate Maleate)
Prevents and treats postabortal hemorrhage due to uterine atony by producing a firm contraction of the uterus within minutes. Although intended primarily for IM administration, faster response can be achieved through IV administration. However, because IV route produces higher incidence of adverse effects, reserve for emergencies such as excessive uterine bleeding. Severe uterine bleeding may require repeated doses but seldom requires more than 1 injection q2-4h.
Methylergonovine (Methergine)
Acts directly on the smooth muscle of the uterus; induces a rapid and sustained tetanic uterotonic effect that reduces bleeding.
