Puerperal infection after cesarean delivery: evaluation of a standardized protocol

Am J Obstet Gynecol. 2000 May;182(5):1147-51. doi: 10.1067/mob.2000.103249.


Objective: Our goal was to evaluate an antibiotic protocol for treatment of postcesarean endometritis.

Study design: Endometritis was diagnosed as a persistent fever > or =100.4 degrees F beyond 24 hours after cesarean delivery and one or more of the following: uterine tenderness, tachycardia, foul lochia, or leukocytosis. Antibiotic therapy included gentamicin plus clindamycin and ampicillin (or vancomycin) as a triple antimicrobial in 148 women. Antibiotic failure was defined as persistent fever after 5 days of antibiotics and 72 hours of triple antibiotics.

Results: Between 1993 and 1996, 322 of 1643 (20%) women were diagnosed with postcesarean endometritis. One hundred seventy-four patients (54%) were cured with clindamycin-gentamicin, and 129 who additionally received ampicillin or vancomycin (40%) were cured. Nineteen of the 322 (6%) women had persistent fever despite triple antibiotics. Of these, 6 had a wound complication, 12 were suspected to have antimicrobial resistance, and 1 had an infected hematoma.

Conclusion: A prospective protocol consisting of clindamycin-gentamicin plus the selective addition of ampicillin or vancomycin cured 303 of 322 (94%) women with postcesarean endometritis.

MeSH terms

  • Ampicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use*
  • Cesarean Section / adverse effects*
  • Clindamycin / therapeutic use
  • Drug Resistance, Microbial
  • Drug Therapy, Combination
  • Endometritis / diagnosis
  • Endometritis / drug therapy*
  • Female
  • Fever
  • Gentamicins / therapeutic use
  • Humans
  • Leukocytosis
  • Postoperative Complications / drug therapy*
  • Pregnancy
  • Puerperal Disorders*
  • Tachycardia
  • Vancomycin / therapeutic use


  • Anti-Bacterial Agents
  • Gentamicins
  • Clindamycin
  • Vancomycin
  • Ampicillin