Endometritis

Diagnosis Common Pathogens Drug(s) of First Choice Alternative Drug(s) Comments Expected Duration
Endometritis

Bacteroides
Prevotella bivia

Group B & A streptococci
Enterobacteriaceae
M. hominis

1st line:
Cefoxitin

2nd line:
Ertapenem

3rd line:
Ampicillin/sulbactam

For severe PCN allergy:
Vancomycin
PLUS
Gentamicin
PLUS
Metronidazole

If test for chlamydia is positive add azithromycin or doxycycline.

Continue antibiotics until afebrile for 24-48 hours.

If still febrile > 48 hours on antibiotics postpartum: If on cefoxitin or clindamycin/gentamicin switch to ertapenem. Wait 48 hours on an antibiotic regimen before considering regimen failed.