Patients delivered by
cesarean section are at risk for postoperative infectious morbidity, especially those patients who have labored with ruptured membranes for a long period of time. The bacteria involved in these
infections are predominantly those of the patient's lower genital tract, both aerobes and anaerobes.
Antibiotic prophylaxis has reduced the risk of postpartum
infection but has also resulted in selection of resistant bacteria. Treatment of postpartum
endometritis has classically been with
clindamycin plus an
aminoglycoside. However, the newer
beta-lactam antibiotics have proved to be just as efficacious. A significant advance in the treatment of postpartum
endometritis is the use of
beta-lactamase inhibitors combined with
beta-lactams, such as
clavulanic acid plus
ticarcillin or
ampicillin plus
sulbactam. Regardless of which
antibiotic is chosen for treatment, it is important to know the weakness of each
antibiotic. For example,
cephalosporins such as
cefoxitin or
cefotetan do not have activity against Strep. faecalis, Ent. cloacae, or Pseudomonas aerugenosa;
mezlocillin,
ticarcillin, or
piperacillin tend to be weakest against the gram-negative facultative anaerobes; and combinations such as
clindamycin plus
gentamicin do not provide coverage against Strep. faecalis. This knowledge of the weakness of the different
antibiotics permits appropriate additions to the
antibiotic regimen and avoids irrational changes in
antibiotic therapy.