From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For postpartum fever treatment, the recommended dosing is gentamicin 5 mg/kg IV once daily (typically 320-400 mg for most adults) plus clindamycin 900 mg IV every 8 hours. This combination provides broad-spectrum coverage against the polymicrobial infections commonly seen in postpartum endometritis, with gentamicin targeting gram-negative organisms and clindamycin covering anaerobes and group A streptococci.
Key Considerations
- Treatment should continue until the patient has been afebrile for 24-48 hours, typically 2-3 days total, after which oral antibiotics are generally not necessary.
- For gentamicin, renal function should be monitored, and the dose adjusted accordingly in patients with impaired kidney function.
- If the patient has a penicillin allergy, this regimen is appropriate, but for non-allergic patients, ampicillin 2g IV every 6 hours is often added to provide enhanced enterococcal coverage.
- Clinical improvement should be evident within 48-72 hours; if fever persists, further evaluation for retained products of conception, wound infection, or other complications is warranted.
Evidence Support
The most recent and highest quality study supporting this recommendation is from 2015, which compared different antibiotic regimens for postpartum endometritis and found that the combination of clindamycin and gentamicin is appropriate for treatment 1. Additionally, a study from 2003 found that once-daily dosing with gentamicin and clindamycin has a similar success rate as the standard every 8-hour dosing schedule 2.
Important Notes
- The quality of the evidence using GRADE comparing clindamycin and an aminoglycoside with another regimen was low to very low for therapeutic failure, severe complications, wound infection, and allergic reaction 1.
- Regimens with good activity against penicillin-resistant anaerobic bacteria are better than those with poor activity against penicillin-resistant anaerobic bacteria 1.
- There is no evidence that any one regimen is associated with fewer side-effects 1.