A woman develops fever (38.5°C), uterine tenderness, foul-smelling lochia, and leukocytosis on day 3 postpartum following vaginal delivery. Blood cultures are negative. What is the FIRST-LINE antibiotic regimen for this clinical presentation of postpartum endometritis?

• A Oral amoxicillin-clavulanate for 7 days
• B IV ampicillin plus IV metronidazole plus IV gentamicin (triple therapy)
• C IV cefazolin 1 g every 8 hours
• D IV clindamycin 900 mg every 8 hours plus IV gentamicin 1.5 mg/kg every 8 hours ✓

Explanation

Clindamycin plus gentamicin is the gold-standard first-line regimen for postpartum endometritis based on multiple RCTs. This combination provides aerobic Gram-negative (gentamicin) and anaerobic/Gram-positive (clindamycin) coverage for the polymicrobial infection. It achieves clinical cure rates > 90%. IV treatment is continued until the patient is afebrile for 24–48 hours; oral follow-up is usually not required unless bacteremia is documented.

Reference: Williams Obstetrics, 26th ed.

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