{ "schema_version": 1, "kind": "condition", "id": "abnormal-lochia", "name": "Abnormal lochia (postpartum vaginal discharge)", "category": "infectious", "sources": "Egyptian National Drug Formulary - Antimicrobial 2023: endometritis appears only under injectable agents (cefoperazone, cefoperazone/sulbactam, cefotaxime, clindamycin) · No dose - referral pathway, no medicine given in primary care · Postpartum Infection - StatPearls - NCBI Bookshelf (NBK560804)", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Antimicrobial 2023: endometritis appears only under injectable agents (cefoperazone, cefoperazone/sulbactam, cefotaxime, clindamycin) · No dose - referral pathway, no medicine given in primary care · Abnormal lochia (postpartum vaginal discharge) - disease-level clinical article (abnormal-lochia-clinical.txt) · Postpartum Infection - StatPearls - NCBI Bookshelf (NBK560804)", "verified_date": "2026-08", "treatments": [ { "id": 5, "generic": "No drug therapy in primary care (Referral & Advice)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Lochia that turns offensive, becomes heavy again after settling, or comes with fever or lower abdominal pain is postpartum endometritis or retained products until proved otherwise. Both are assessed with an examination, a swab and an ultrasound, and both are treated with intravenous antibiotics or evacuation. Neither is a prescription written in a clinic.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": "The Egyptian National Drug Formulary lists endometritis only under injectable agents - cefoperazone, cefoperazone with sulbactam, cefotaxime and clindamycin. It holds no oral course, so recognise this and refer the same day. The oral regimens below come from an international source rather than the formulary, and they apply only to the woman who is systemically well.", "cautions": [ "Fever, offensive lochia, uterine tenderness, or a uterus that is not involuting: refer the same day.", "Heavy fresh bleeding after the first 24 hours is secondary postpartum haemorrhage. That is an emergency, not a discharge problem.", "Normal lochia is red for about 3-4 days, then brownish, then pale, and has finished by 4-6 weeks. Bright red bleeding returning after it has gone pale is abnormal.", "Ask about the delivery. Prolonged rupture of membranes, caesarean section, manual removal of the placenta and repeated vaginal examinations all raise the risk of endometritis.", "Never start an oral antibiotic and review in a week. Postpartum sepsis moves faster than that, and it remains a leading cause of maternal death. The oral courses below are for the systemically well woman only - afebrile, normal pulse and blood pressure, no rigors, no severe pain, no heavy bleeding - and they are reviewed at 48 hours.", "Take the observations. A postpartum woman compensates well and then decompensates suddenly - a normal-looking patient with a tachycardia is the one to worry about.", "RED FLAG - Keep a high index of suspicion for sepsis in postpartum patients with unexplained end-organ dysfunction, even in the absence of fever." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable - this is a postpartum condition.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "abnormal-lochia" }, { "id": 6, "generic": "Amoxicillin + Clavulanic acid", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 1000.0, "adult_dose": "875/125 mg orally twice daily", "adult_duration": "14 days", "dose_source": "Postpartum Infection - StatPearls - NCBI Bookshelf (NBK560804) - verbatim: \"Potential 14-day regimens for treatment of postpartum endomyometritis include clindamycin 600 mg orally every 6 hours plus gentamicin intramuscularly 4.5 mg/kg every 24 hours; amoxicillin-clavulanate 875 mg orally twice daily; cefotetan 2g intramuscularly every 8 hours; meropenem or imipenem-cilastatin 500 mg intramuscularly every 8 hours; or oral amoxicillin 500 mg and metronidazole 500 mg every 8 hours.\" The same source states the outpatient regimens are safe in breastfeeding and cure over 85% of early cases.", "rationale": "Single-agent oral cover for the mixed aerobic and anaerobic flora of postpartum endometritis, for the systemically well woman only, reviewed at 48 hours. It is an international regimen, not an Egyptian National Drug Formulary one - the formulary lists endometritis only under injectable agents.", "cautions": [ "The gate, before the dose: she must be afebrile with normal pulse and blood pressure, no rigors, no severe pain, no heavy bleeding, and a uterus that is involuting. Review in 48 hours. Fail any one of those and she is referred the same day.", "Take the observations before deciding. A postpartum woman compensates well and then decompensates suddenly - a normal-looking patient with a tachycardia is not a well woman.", "Safe while breastfeeding. StatPearls' postpartum infection article rates these oral regimens safe during breastfeeding, with a cure rate above 85% in early endometritis. There is no need to stop feeding.", "The full 14 days. This is not a 5-day course: a short one relapses and risks pelvic infection.", "No oral penicillin-free option exists at GP level here. The source's only non-beta-lactam regimen is clindamycin plus INTRAMUSCULAR gentamicin, so a woman with penicillin allergy needs referral, not a substitution." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Condition restricted to postpartum women", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "E-MOXCLAV 1G 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 14.0, "pack_count": 10, "unit_price": 1.4, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "JULMENTIN 2X 1GM 15 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 57.5, "pack_count": 15, "unit_price": 3.83, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DEXICLAVE 1 GM 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > NOVELL PHARMA", "price_egp": 38.5, "pack_count": 10, "unit_price": 3.85, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MACLAVEX 1 GM 14 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE", "price_egp": 105.0, "pack_count": 14, "unit_price": 7.5, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLAVIMOX 1 GM 12 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 130.0, "pack_count": 12, "unit_price": 10.83, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MEGAMOX 1 GM 14 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AL JAZEERA PHARMACEUTICAL > HIKMA PHARMA", "price_egp": 178.0, "pack_count": 14, "unit_price": 12.71, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > ORGANOPHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 169.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR > AL ROWAD PHARMACEUTICAL INDUSTRIAL CO.", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 8.0, "pack_count": null, "unit_price": null, "strength_mg": 156.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "abnormal-lochia" }, { "id": 7, "generic": "Amoxicillin", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "500 mg orally every 8 hours, given together with metronidazole", "adult_duration": "14 days", "dose_source": "Postpartum Infection - StatPearls - NCBI Bookshelf (NBK560804) - verbatim: \"... or oral amoxicillin 500 mg and metronidazole 500 mg every 8 hours\", from the same sentence naming these as 14-day regimens for postpartum endomyometritis.", "rationale": "The two-drug oral alternative when co-amoxiclav is not available or not tolerated, for the systemically well woman only. Amoxicillin covers the aerobes; metronidazole covers the anaerobes.", "cautions": [ "The gate, before the dose: she must be afebrile with normal pulse and blood pressure, no rigors, no severe pain, no heavy bleeding, and a uterus that is involuting. Review in 48 hours. Fail any one of those and she is referred the same day.", "Both drugs, not one. Amoxicillin alone does not cover the anaerobes that cause the offensive smell.", "Safe while breastfeeding. StatPearls' postpartum infection article rates these regimens safe during breastfeeding, with a cure rate above 85% in early endometritis." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Condition restricted to postpartum women", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "AMOXYCILLIN 500MG 10 CAPS B.P.2013", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARAB DRUG COMPANY (ADCO)", "price_egp": 6.5, "pack_count": 10, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMOXICILLIN 500MG 12 CAPS. USP 28", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OCTOBER PHARMA", "price_egp": 8.1, "pack_count": 12, "unit_price": 0.67, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMOXIL 500MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > SMITHKLINE BEECHAM", "price_egp": 9.0, "pack_count": 12, "unit_price": 0.75, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMOXICID 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 9.5, "pack_count": 12, "unit_price": 0.79, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "E-MOX 500 MG 16 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 15.6, "pack_count": 16, "unit_price": 0.97, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HICONCIL 500MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 11.6, "pack_count": 12, "unit_price": 0.97, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "BIOMOX 500MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SEDICO", "price_egp": 19.5, "pack_count": 12, "unit_price": 1.62, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "IBIAMOX 500 MG 12 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 45.0, "pack_count": 12, "unit_price": 3.75, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "HICILLIN 125MG/5ML SUSP. 80ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 3.0, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "AMOXIL FORT 250MG/5ML SUSP. 60ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP > SMITHKLINE BEECHAM", "price_egp": 5.5, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "abnormal-lochia" }, { "id": 8, "generic": "Metronidazole", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "500 mg orally every 8 hours, given together with amoxicillin", "adult_duration": "14 days", "dose_source": "Postpartum Infection - StatPearls - NCBI Bookshelf (NBK560804) - verbatim: \"... or oral amoxicillin 500 mg and metronidazole 500 mg every 8 hours\", from the same sentence naming these as 14-day regimens for postpartum endomyometritis.", "rationale": "The anaerobic half of the two-drug oral regimen, for the systemically well woman only. Anaerobes are what make the lochia offensive.", "cautions": [ "The gate, before the dose: she must be afebrile with normal pulse and blood pressure, no rigors, no severe pain, no heavy bleeding, and a uterus that is involuting. Review in 48 hours. Fail any one of those and she is referred the same day.", "Strictly no alcohol during the course and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023.", "Safe while breastfeeding. StatPearls' postpartum infection article rates these regimens safe during breastfeeding, with a cure rate above 85% in early endometritis. It can give the milk a bitter taste - that is not a reason to stop feeding.", "May cause a metallic taste and nausea." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Condition restricted to postpartum women", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "DUMOZOL 500MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > ALPHARMA-DENMARK", "price_egp": 7.0, "pack_count": 20, "unit_price": 0.35, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOLGUARD 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UNIPHARMA CO. > UNIPHARMA", "price_egp": 9.0, "pack_count": 20, "unit_price": 0.45, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NITROFECTAZOLE 500 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GYPTO PHARMA", "price_egp": 10.5, "pack_count": 20, "unit_price": 0.53, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLAGICURE FORTE 500 MG 20 F.C. TAB", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 23.0, "pack_count": 20, "unit_price": 1.15, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRICHOGYL 500MG 12 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NASR", "price_egp": 15.0, "pack_count": 12, "unit_price": 1.25, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLAGELLAT FORTE 500MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 30.0, "pack_count": 20, "unit_price": 1.5, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "GEDAZOLE 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JEDCO INT. CO. FOR PHARMACEUTICALS", "price_egp": 34.0, "pack_count": 20, "unit_price": 1.7, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METROGYPTON 500 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GYPTO PHARMA", "price_egp": 34.0, "pack_count": 20, "unit_price": 1.7, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DUMOZOL 125MG/5ML SUSP. 125ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MINA PHARM > ALPHARMA-DENMARK", "price_egp": 5.75, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "METROZOLE 125MG/5ML SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 19.5, "pack_count": null, "unit_price": null, "strength_mg": 125.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "abnormal-lochia" } ] }