From the Guidelines
Endometritis is treated primarily with antibiotics, typically a broad-spectrum regimen to cover common causative organisms, such as N. gonorrhoeae, C. trachomatis, anaerobes, Gram-negative facultative bacteria, and streptococci, as recommended by the Centers for Disease Control and Prevention 1. The treatment regimen should provide empiric coverage of likely pathogens. For mild to moderate cases, oral doxycycline 100mg twice daily for 14 days is often prescribed, sometimes combined with metronidazole 500mg twice daily for anaerobic coverage. Some key points to consider in the treatment of endometritis include:
- The need for broad-spectrum antibiotic coverage to address the various potential pathogens involved 1.
- The importance of completing the full antibiotic course, even if symptoms improve quickly, to prevent recurrence and potential complications such as pelvic inflammatory disease, abscess formation, or sepsis.
- The role of rest, adequate hydration, and anti-inflammatory medications like ibuprofen 400-600mg every 6 hours in managing associated pain and inflammation.
- The potential need for surgical intervention, such as dilation and curettage, in cases related to retained products of conception, alongside antibiotic therapy 1. For severe or postpartum endometritis, intravenous therapy may be initiated with clindamycin 900mg every 8 hours plus gentamicin 5mg/kg daily until the patient is afebrile for 24-48 hours, then transitioning to oral antibiotics to complete a 14-day course. Follow-up evaluation is important to ensure complete resolution of the infection and to address any potential complications promptly.
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. The treatment for endometritis is metronidazole tablets, which are indicated for the treatment of gynecologic infections, including endometritis, caused by susceptible anaerobic bacteria 2.
- The treatment should be used in conjunction with indicated surgical procedures.
- In a mixed aerobic and anaerobic infection, antimicrobials appropriate for the treatment of the aerobic infection should be used in addition to metronidazole tablets.