How is postpartum endometritis treated?

Updated: Oct 11, 2019
  • Author: Andy W Wong, MD; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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In most cases, initial antimicrobial treatment is a combination of an aminoglycoside and clindamycin. Alternatively, an aminoglycoside plus metronidazole with or without ampicillin may also be used. [13]

Mild cases of endometritis after vaginal delivery may be treated with oral antimicrobial agents (eg, doxycycline, clindamycin).

Moderate-to-severe cases, including those involving cesarean deliveries, should be treated with parenteral broad-spectrum antimicrobials.

A review of trials for antibiotic regimens for the treatment of endometritis by French and Smaill concluded that gentamicin in combination with clindamycin is appropriate for endometritis. [14]  In an update of these findings, on the basis of a Cochrane review of 42 trials comprising more than 4200 patients, investigators confirmed combination therapy with gentamicin and clindamycin remains appropriate for treatment of endometritis. [15]  The researchers also noted that the use of additional oral therapy has not been proven to be beneficial.

In general, the patient's condition rapidly improves after antibiotics are administered. 

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