Intravenous gentamicin plus clindamycin more effective than other antibiotics for endometritis after childbirth.
Inflammation of the lining of the womb (postpartum endometritis), also known as puereral fever, is caused by infection entering the womb (uterus) during childbirth. It occurs in about 1% to 3% of births, and is up to ten times more common after caesarean section. Prolonged rupture of membranes and multiple vaginal examinations also appear to increase the risk. Endometritis causes fever, uterine tenderness and unpleasant-smelling lochia, and it can have serious complications such as abscess formation, sepsis and blood clots. It is also an important cause of maternal mortality worldwide, although this is very rare in high-income countries with the use of antibiotics. There can be early-onset form, occurring within 48 hours, or late-onset, up to six weeks after the birth. There are many antibiotic treatments currently in use. The review compared different antibiotics, routes of administration and dosages. The review identified 39 studies involving 4221 women, although overall they were not methodologically strong and often funded by the drug companies. The combination of intravenous gentamicin and clindamycin, and drugs with a broad range of activity against bacteria including certain penicillin-resistant strains, were found to be most effective for treating endometritis after childbirth. There was no evidence that any treatment had fewer adverse effects than others, but no studies looked at outcomes on the baby and there are no data on the possible development drug resistance. If the endometritis was uncomplicated and improved with intravenous antibiotics, there was no need to follow with an oral course of drugs.