A woman develops post-cesarean metritis with uterine tenderness and fever on day 3. She is haemodynamically stable with no allergy history. Which parenteral regimen is the standard first-line combination therapy?

• A Ceftriaxone plus metronidazole
• B Meropenem monotherapy
• C Ampicillin-sulbactam plus doxycycline
• D Clindamycin plus gentamicin ✓

Explanation

Postpartum endometritis is a mixed infection involving anaerobes, aerobic gram negatives, and gram positives, and the classic standard regimen remains intravenous clindamycin plus gentamicin, continued until 24 to 48 hours of clinical improvement. This combination covers anaerobes and enterobacteriaceae respectively. Doxycycline is avoided in the puerperium because of breastfeeding considerations, and carbapenems are reserved for failures.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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