Hospitalized Adults: Gynecologic Infections: Endometritis

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Endometritis 

Bacteroides

Prevotella bivia

Group B & Astreptococci

Enterobacteriaceae

M. hominis 

1st line:

Cefoxitin 2 g IV q6h

 

2nd line:

Ertapenem 1 g IV daily

 

3rd line:

Ampicillin/sulbactam 3 g IV q6h

For severe PCN allergy:

Vancomycin

PLUS

Gentamicin

PLUS

Metronidazole 500 mg IV q12h 

If test for chlamydia is positive add azithromycin or doxycycline. 

Continue antibiotics until afebrile for 24-48 hours.

If still febrile > 48 hours and on cefoxitin or clindamycin/gentamicin postpartum, switch to ertapenem. 

Wait 48 hours on an antibiotic regimen before considering regimen failed.