| Excerpt from The WHO Reproductive Health Library | Published by Update Software Ltd. |
Thirty-eight randomized trials of different antibiotic regimens for the treatment of postpartum endometritis after caesarean section or vaginal delivery were included in this review. The main outcome measures in these trials were treatment failure, complications and side-effects. A combination of clindamycin and gentamycin was associated with statistically significantly fewer treatment failures than other antibiotics. (Four trials, 463 women, relative risk [RR]: 0.70; 95% confidence interval [CI]: 1.09–1.00) There were fewer failures with once daily dosage of gentamycin compared with a thrice daily dosage. Regimens of antibiotics not active against penicillin-resistant anaerobic bacteria had significantly more treatment failures. Overall, there were no differences between the antibiotics in terms of side-effects, except for significantly less diarrhoea with second and third generation cephalosporins. Continuation of intravenous treatment with oral treatment did not yield any additional benefits.
All randomized trials which met eligibility criteria specified in the protocol were included and appropriately analysed. A subgroup analysis of the antibiotics by route of delivery could not be conducted owing to lack of adequate data.
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