Time to antibiotic administration in intra-amniotic infections: impact of cefoxitin monotherapy versus traditional antibiotic therapy.

Objective: This study addresses treatment of intra-amniotic infection (IAI) by comparing timely receipt of recommended antibiotic administration between cefoxitin and traditional antimicrobial therapy, ampicillin and gentamicin, with or without clindamycin. Methods: This retrospective cohort study was conducted at a large, multi-site health system. The combination therapy group treated with ampicillin plus gentamicin, with or without clindamycin from June 2022 to May 2023, was compared to patients treated with cefoxitin from June 2023 to May 2024, following an institutional guideline update. Participants: Pregnant individuals aged 16 and older with diagnosed or presumed IAI were included. Results: Three hundred patients were included, 150 each in both the combination therapy and cefoxitin groups. Baseline characteristics were similar between the combination therapy and cefoxitin patients. Vaginal delivery was the most common mode of delivery, and rates of cesarean delivery were similar between groups. Most patients had a negative group B Conclusions: Cefoxitin for IAI significantly improves timeliness of recommended antibiotic treatment, aligning with current guideline recommendations for prompt therapy. The absence of differences in secondary outcomes supports the clinical efficacy of cefoxitin and its consideration as a first-line agent in the management of IAI.