A 30-year-old woman develops puerperal pyrexia on day 3 post-normal vaginal delivery. Temperature is 38.6°C. Examination reveals a tender, bulky uterus with foul-smelling lochia. WBC is 18,000/µL. The most likely causative organism and appropriate antibiotic regimen is:
- A Group A Streptococcus; IV penicillin G alone
- B Polymicrobial (anaerobes, gram-negatives, enterococci); IV clindamycin + gentamicin (± ampicillin) ✓
- C Staphylococcus aureus; IV flucloxacillin
- D Chlamydia trachomatis; oral doxycycline for 14 days
Correct answer: B. Polymicrobial (anaerobes, gram-negatives, enterococci); IV clindamycin + gentamicin (± ampicillin)
Explanation
Puerperal endometritis is characteristically polymicrobial, involving anaerobes (Bacteroides, Peptostreptococcus), gram-negative aerobes (E. coli, Klebsiella), and enterococci. The gold-standard regimen is IV clindamycin plus gentamicin, which covers the full polymicrobial spectrum (anaerobes and gram-negatives); ampicillin may be added for enterococcal coverage. Group A Streptococcus causes fulminant puerperal sepsis but penicillin alone is insufficient for polymicrobial endometritis. Chlamydia causes late postpartum endometritis (> 2 weeks).
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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