A woman develops fever on day 4 postpartum after an emergency cesarean section. She has uterine tenderness, foul-smelling lochia, and WBC of 18,500/µL. Cultures are pending. What is the MOST appropriate first-line empirical antibiotic regimen?

• A Oral amoxicillin-clavulanate for 7 days
• B IV piperacillin-tazobactam monotherapy
• C IV ceftriaxone + metronidazole
• D IV gentamicin + clindamycin (the Gibbs regimen) ✓

Explanation

Endomyometritis (puerperal endometritis) after cesarean section is a polymicrobial infection. The classic combination of IV gentamicin (coverage of Gram-negative aerobes) + clindamycin (coverage of anaerobes and Gram-positive organisms) — the Gibbs regimen — remains the standard first-line empirical treatment per most obstetric guidelines and shows >90% clinical cure rates. Adding ampicillin provides enterococcal coverage in refractory cases. Oral therapy is inadequate for febrile post-CS endometritis.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.