A 29-year-old pregnant woman with penicillin allergy history was admitted to the hospital due to amenorrhea for 31+ weeks and vaginal discharge for 5 hours.The patient was diagnosed with premature rupture of membranes and had indications for prophylactic use of antibiotics.Clinical pharmacists recommended a penicillin skin test or cefuroxime for treatment after knowing the allergy history of the patient and determining a low risk of immediate penicillin anaphylaxis.But the patient refused the penicillin skin test,and the cefuroxime skin test was positive.The pharmacists proposed vancomycin(1 g,q8h,ivgtt)combined with azithromycin(500 mg po for the first time,250 mg qd po on the second day,4 days for a treatment course).Meanwhile,group B streptococcus(GBS)screening and intrauterine bacterial culture were performed.The result of GBS screening was negative,and the pharmacists recommended that vancomycin should be withdrawn.The result of intrauterine bacterial culture showed the presence of Escherichia coli.It was most likely due to the contamination based on the patient's symptoms,physical signs and laboratory test indexes,and the pharmacists recommended continuing the azithromycin treatment.The patient gave birth by induction of labor due to less amniotic fluid,both mother and infant were in good condition.The patient was discharged after treatment with azithromycin for 5 days,and 2 weeks later,the mother and infant were both in good condition according to the postpartum follow-up.
Premature rupture of membranesPenicillin allergyAntibioticClinical pharmacistPharmaceutical care
维普
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