Postpartum endometritis is a common complication of cesarean sections, and the causative agents of this disease are most often microorganisms that live in the vagina. Antibacterial therapy is an essential part of treating endometritis.

The objective of the Cochrane Pregnancy and Childbirth Group systematic review was to assess the efficacy of various antibiotic regimens in the treatment of postpartum endometritis.

The research was carried out in the special register Cochrane Pregnancy and Childbirth Group and the Cochrane Register of Controlled Research until June 2001.

The review included randomized trials comparing different antibiotic regimens for postpartum endometritis that developed after a conventional birth or cesarean section, which included evidence of treatment failure and the development of complications.

Data collection and analysis were carried out by two researchers independently of each other. Different modes of antibiotic treatment were compared (various antibacterial drugs, duration of treatment and route of administration of antibiotics). As a result, the relative risk has been determined.

The examination included 47 studies. In general, the studies were methodologically inadequate. A study intended to apply the intervention showed that in 15 studies comparing clindamycin and aminoglycosides with other antibiotic regimens, clinical efficacy was more often observed with other antibiotics (relative risk 1, 32, 95% confidence interval 1.09-1, 60). The ineffectiveness of antibiotic therapy has been associated with the low activity of drugs against anaerobic bacteria resistant to penicillin (relative risk 1.53, 95% confidence interval 1,1-2,13). In four studies that compared the long-term use of oral antibiotics after parenteral (IV) administration, there were no statistically significant differences in the main endpoints evaluated. No difference was found in the frequency of allergic reactions. When cephalosporins were used, diarrhea occurred less frequently.

Thus, the combination of gentamicin and clindamycin is suitable for the treatment of postpartum endometritis. In the treatment of uncomplicated endometritis, clinical improvement occurs with the use of iv therapy, and there is no need to prescribe long-term oral antibiotic therapy.