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Antibiotic regimens for endometritis after deliveryFrench L, Smaill FM
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SummaryAntibiotic regimens for endometritis after deliveryIntravenous 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.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
April 24. 2000 AbstractBackgroundPostpartum endometritis, which is more common after cesarean section, occurs when vaginal organisms invade the endometrial cavity during labor and birth. Antibiotic treatment is warranted. ObjectivesThe effect of different antibiotic regimens for the treatment of postpartum endometritis on failure of therapy and complications was systematically reviewed. Search strategyWe searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2007). Selection criteriaRandomized trials of different antibiotic regimens for postpartum endometritis, after cesarean section or vaginal birth, where outcomes of treatment failure or complications were reported were selected. Data collection and analysisWe abstracted data independently and made comparisons between different types of antibiotic regimen based on type of antibiotic and duration and route of administration. Summary relative risks were calculated. Main resultsThirty-nine trials with 4221 participants were included. Fifteen studies comparing clindamycin and an aminoglycoside with another regimen showed more treatment failures with the other regimen (relative risk (RR) 1.44; 95% confidence interval (CI) 1.15 to 1.80). Failures of those regimens with poor activity against penicillin resistant anaerobic bacteria were more likely (RR 1.94; 95% CI 1.38 to 2.72). In three studies that compared continued oral antibiotic therapy after intravenous therapy with no oral therapy, no differences were found in recurrent endometritis or other outcomes. In four studies comparing once daily with thrice daily dosing of gentamicin there were fewer failures with once daily dosing. There was no evidence of difference in incidence of allergic reactions. Cephalosporins were associated with less diarrhea. Authors' conclusionsThe combination of gentamicin and clindamycin is appropriate for the treatment of endometritis. Regimens with activity against penicillin-resistant anaerobic bacteria are better than those without. There is no evidence that any one regimen is associated with fewer side-effects. Once uncomplicated endometritis has clinically improved with intravenous therapy, oral therapy is not needed. |