How should I initiate antibiotic therapy for a patient diagnosed with puerperal sepsis in a primary care setting?

Initiate antibiotic therapy for puerperal sepsis by first taking microbiological specimens for culture, including blood cultures, before starting antimicrobials. This is essential to guide targeted therapy and is in line with NICE guidelines on sepsis.

Start broad-spectrum intravenous antibiotics promptly, especially if the source of infection is unclear, following local antimicrobial guidelines or national recommendations. There is no evidence to support the superiority of one broad-spectrum antimicrobial over another, so choice should be guided by local protocols.

Document the rationale for starting antimicrobial treatment and the choice of antibiotic clearly in the patient’s records.

Ensure ongoing multidisciplinary review and monitoring of the patient, including vital signs and clinical response to treatment, with escalation to specialist care if organ dysfunction or severe illness signs develop.