What is the recommended initial treatment for postpartum endometritis?

Postpartum endometritis is an infection of the endometrium that typically occurs after delivery, particularly following cesarean sections or prolonged labor, and is often characterized by fever and uterine tenderness. The initial treatment for postpartum endometritis is typically intravenous antibiotics, as the condition can lead to significant morbidity if not treated promptly and effectively.

Intravenous clindamycin and gentamicin is the preferred regimen because it provides broad coverage against the polymicrobial flora commonly found in the postpartum uterus. This combination targets both aerobic and anaerobic bacteria, which are frequently involved in the infection. Clindamycin is effective against anaerobes, while gentamicin provides coverage for gram-negative organisms, making this regimen highly effective for managing postpartum endometritis.

Other treatment options, such as oral antibiotics or observation, are not suitable for initial management because they do not ensure adequate coverage or may delay necessary treatment. Surgical intervention may be warranted in cases where there is an abscess or if there is no improvement with antibiotic therapy but is not considered the initial step for uncomplicated endometritis. Starting with intravenous therapy provides the most effective and immediate treatment to control the infection and support recovery.