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.