Home > Treatment Recommendations > Adult Patients > Genital > Endometritis > Postpartum (0-6 weeks)

Postpartum (0-6 weeks)

- Caesarean section is a major risk factor for postpartum endometritis. The presence of bacterial vaginosis increases that risk.

Diagnosis:

blood cultures
culture of caesarean incision if wound infection is suspected
culture of vaginal secretions; indicate post-partum on lab requisition

- Consider septic pelvic vein thrombophlebitis in those with bacteremia/severe presentation or lack of response after 48-72 hours of appropriate antibiotic therapy. Infectious Diseases consult recommended.

Potential Pathogens

Polymicrobial: aerobic and anaerobic organisms

Metamycoplasma hominis (previously Mycoplasma hominis)

S. pyogenes (Group A Streptococcus)

S. agalactiae (Group B Streptococcus)

S. aureus

Clostridium spp

Empiric Therapy	Dose	Duration
Ceftriaxone	1-2g IV daily	Clinical improvement expected after 48-72 hours. Continue antibiotics for 24-48 hours after fever and pain resolved.
+
Metronidazole	500mg IV/PO bid
+/-
Doxycycline	100mg PO bid

Ceftriaxone allergy

Empiric Therapy	Dose	Duration
Clindamycin	600mg IV q8h	Clinical improvement expected after 48-72 hours. Continue antibiotics for 24-48 hours after fever and pain resolved.
+
Gentamicin	5-7mg/kg IV q24h

If mild illness or cannot treat with IV drugs:

Empiric Therapy	Dose	Duration
Amoxicillin-clavulanate	875mg PO bid	Clinical improvement expected after 48-72 hours. Continue antibiotics for 24-48 hours after fever and pain resolved.
+/-
Doxycycline	100mg PO bid

Penicillin/amoxicillin allergy

Empiric Therapy	Dose	Duration
Cefuroxime axetil	500mg PO bid	Clinical improvement expected after 48-72 hours. Continue antibiotics for 24-48 hours after fever and pain resolved.
+
Metronidazole	500mg PO bid
+/-
Doxycycline	100mg PO bid

Cefuroxime allergy

Empiric Therapy	Dose	Duration
Clindamycin alone	450mg PO qid	Clinical improvement expected after 48-72 hours. Continue antibiotics for 24-48 hours after fever and pain resolved.