What is the role of antibiotic therapy in the treatment of endometritis?

Updated: Apr 25, 2019
  • Author: Michel E Rivlin, MD; Chief Editor: Michel E Rivlin, MD  more...
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Answer

The combination of clindamycin and gentamicin administered intravenously every 8 hours has been considered the criterion standard treatment. Some studies have revealed adequate efficacy with once-daily dosing, as well. [17, 18, 19, 20] The combination of a second- or third-generation cephalosporin with metronidazole is another popular choice.

The CDC 2015 STD treatment guidelines include details of recommended antibiotic regimens. [1, 2]

In teenagers, postabortion endometritis may be caused by organisms that cause pelvic inflammatory disease (PID). The initial treatment regimen in these patients usually includes intravenous cefoxitin and doxycycline, in the same doses as for PID.

A trend toward the use of broad-spectrum monotherapy has emerged; these agents are generally effective in 80-90% of patients. Cephalosporins, extended-spectrum penicillins, and fluoroquinolones are used as monotherapy. [21]

Improvement is noted within 48-72 hours in nearly 90% of women. Parenteral therapy is continued until the patient has been afebrile for longer than 24 hours. If the physical examination findings are benign, the patient may be discharged at that time. Further outpatient antibiotic therapy has proved to be unnecessary. If the patient does not improve in the expected 48- to 72-hour period, reevaluate for complications such as abscess.


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