What is the diagnosis and treatment for endometritis (inflammation of the endometrium)?

From the Guidelines

Endometritis should be treated with empiric, broad-spectrum antibiotics that cover likely pathogens, including N. gonorrhoeae, C. trachomatis, anaerobes, Gram-negative facultative bacteria, and streptococci, as recommended by the Centers for Disease Control and Prevention 1. The goal of treatment is to eliminate the infection, reduce morbidity, and prevent long-term complications such as tubal infertility and ectopic pregnancy.

Diagnosis and Treatment

• The diagnosis of endometritis can be supported by the presence of oral temperature >101 F (>38.3 C), abnormal cervical or vaginal mucopurulent discharge, presence of white blood cells (WBCs) on saline microscopy of vaginal secretions, elevated erythrocyte sedimentation rate, and elevated C-reactive protein 1.
• The most specific criteria for diagnosing endometritis include endometrial biopsy with histopathologic evidence of endometritis, transvaginal sonography or magnetic resonance imaging techniques showing thickened, fluid-filled tubes with or without free pelvic fluid or tubo-ovarian complex, and laparoscopic abnormalities consistent with PID 1.
• Treatment regimens should provide broad-spectrum coverage of likely pathogens, and several antimicrobial regimens have been effective in achieving clinical and microbiologic cure in randomized clinical trials with short-term follow-up 1.

Management

• Patients with endometritis should receive prompt treatment with antibiotics, and the specific regimen may depend on the severity of the infection and the presence of any underlying medical conditions.
• Rest, adequate hydration, and over-the-counter pain relievers like ibuprofen can help manage symptoms.
• It is essential to complete the full course of antibiotics even if symptoms improve quickly to ensure that the infection is fully eliminated.

Prevention

• Endometritis can be prevented by reducing the risk of bacterial infection, such as using condoms during sexual intercourse, practicing good hygiene, and avoiding unnecessary gynecological procedures.
• Women who have had recent childbirth, abortion, or gynecological procedures should be aware of the symptoms of endometritis and seek medical attention promptly if they occur.

From the FDA Drug Label

GYNECOLOGIC INFECTIONS, including endometritis, endomyometritis, tubo‑ovarian abscess, and postsurgical vaginal cuff infection, caused by Bacteroides species including the B. fragilis group, Clostridium species, Peptococcusniger, and Peptostreptococcus species. Infections of the female pelvis and genital tract such as endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection.

Metronidazole and clindamycin are indicated for the treatment of endometritis caused by susceptible anaerobic bacteria 2 3.

• Metronidazole is effective against Bacteroides species, Clostridium species, Peptococcusniger, and Peptostreptococcus species.
• Clindamycin is effective against susceptible strains of streptococci, pneumococci, staphylococci, and anaerobic bacteria.

From the Research

Definition and Causes of Endometritis

• Endometritis is an infection of the endometrium, which is the lining of the uterus, and can occur after childbirth, miscarriage, or abortion 4.
• The infection is usually caused by bacteria that enter the uterus during the delivery process, and is more common after cesarean section 4, 5.

Treatment of Endometritis

• Antibiotic treatment is the primary treatment for endometritis, and the choice of antibiotic regimen depends on the severity of the infection and the presence of any underlying medical conditions 4, 5.
• The combination of clindamycin and gentamicin is a commonly used antibiotic regimen for the treatment of endometritis, and has been shown to be effective in reducing treatment failures and complications 4, 5.
• Regimens with good activity against penicillin-resistant anaerobic bacteria are also recommended, as they have been shown to be more effective than those with poor activity against these bacteria 4, 5.

Comparison of Antibiotic Regimens

• Studies have compared different antibiotic regimens for the treatment of endometritis, including clindamycin plus an aminoglycoside versus penicillins, and cephalosporins versus clindamycin plus gentamicin 4, 5.
• The results of these studies have shown that clindamycin plus an aminoglycoside is more effective than penicillins, and that cephalosporins are less effective than clindamycin plus gentamicin 4, 5.

Management of Pelvic Inflammatory Disease (PID)

• PID is a related condition that can occur when bacteria infect the upper genital tract, and can cause symptoms such as pelvic pain, fever, and abnormal vaginal discharge 6, 7.
• The treatment of PID typically involves antibiotic therapy, and the choice of antibiotic regimen depends on the severity of the infection and the presence of any underlying medical conditions 6, 7.
• The addition of metronidazole to ceftriaxone and doxycycline has been shown to be effective in reducing endometrial anaerobes and decreasing pelvic tenderness in women with PID 6.

Distinction from Endometriosis

• Endometriosis is a chronic inflammatory disorder in which endometrial tissue grows outside the uterus, and can cause symptoms such as pain, abnormal menstruation, and infertility 8.
• While endometriosis and endometritis are two distinct conditions, they can both cause pelvic pain and other symptoms, and a thorough diagnosis and treatment plan are necessary to manage these conditions effectively 8.