Antibiotic Considerations in the Treatment of Maternal Sepsis

Sepsis, a life-threatening organ dysfunction caused by a dysregulated host response to infection, remains the third leading cause of maternal mortality globally. Pregnancy-associated physiological adaptations predispose pregnant individuals to infection, impair maternal response to infection, affect antibiotic pharmacokinetics and metabolism, and complicate diagnosing infections and sepsis. Therefore, it is tantamount that clinicians readily recognize maternal sepsis and understand antibiotic regimens and treatment principles to avoid adverse maternal outcomes. In this article, we present an overview of the diagnosis and management of maternal sepsis and the physiological changes in pregnancy that alter antibiotic pharmacokinetics. Common microorganisms implicated in maternal sepsis are discussed with an emphasis on E. coli and Group A Streptococcus due to their prevalence and morbidity in the pregnant population. Lastly, we provide an overview of commonly used antibiotics and dosage recommendations in the treatment of maternal infection and sepsis.