A woman 5 days postpartum presents with fever 38.8°C, uterine tenderness, and purulent lochia. Endometritis is diagnosed. She had a cesarean delivery. Which antibiotic regimen is most appropriate?
- A Oral amoxicillin-clavulanate for 7 days
- B IV cefazolin alone
- C IV clindamycin plus gentamicin ✓
- D Oral doxycycline for 14 days
Correct answer: C. IV clindamycin plus gentamicin
Explanation
Post-cesarean endometritis is a polymicrobial infection (gram-negatives, anaerobes, group B streptococcus). The gold-standard treatment regimen is IV clindamycin (900 mg every 8 hours) plus gentamicin (5 mg/kg once daily or divided 8-hourly), which provides broad anaerobic and gram-negative coverage. This combination achieves >90% clinical cure rates. Ampicillin may be added for enterococcal coverage if no improvement in 48–72 hours. Oral regimens are insufficient for post-cesarean endometritis; cefazolin alone lacks anaerobic coverage.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.