What is the first-line treatment for endometritis?

The first-line treatment for endometritis is typically a combination of clindamycin and gentamicin. This treatment approach is favored because it provides broad-spectrum coverage against the polymicrobial flora that often contributes to postpartum and post-abortal endometritis. Clindamycin is effective against anaerobic bacteria and some gram-positive organisms, while gentamicin targets aerobic gram-negative bacteria. The combination effectively addresses the likely pathogens involved in endometritis, including those that can lead to more severe complications if left untreated.

Using this combination maximizes treatment efficacy while minimizing the risk of antibiotic resistance. The choice reflects the clinical understanding of the common infective organisms, which can include species such as Escherichia coli, Streptococcus, and various anaerobes. Hence, this combination therapy is the standard recommendation in various treatment guidelines and within clinical practice.

The other treatment options, while they may have their own therapeutic merits, do not offer the same spectrum of coverage or are not as commonly recommended in guidelines specifically addressing endometritis.