A woman develops fever (39°C), uterine tenderness, and foul-smelling lochia on day 3 postpartum. She had a prolonged labour with multiple vaginal examinations. Blood cultures are pending. What is the MOST appropriate empirical antibiotic regimen?

• A Amoxicillin-clavulanate orally for 7 days
• B IV metronidazole alone for anaerobic coverage
• C IV gentamicin plus clindamycin (with or without ampicillin) ✓
• D Oral doxycycline for chlamydial endometritis

Explanation

Postpartum endometritis (puerperal sepsis) is polymicrobial, typically involving Streptococcus (group A and B), Enterococcus, gram-negative enterics, and anaerobes. The standard empirical IV regimen is clindamycin + gentamicin, which provides broad spectrum coverage against the predominant organisms; ampicillin can be added for Enterococcus coverage. This regimen has >95% clinical cure rates. Oral amoxicillin-clavulanate is appropriate for mild outpatient cases but not for hospital-acquired endometritis with fever.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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