Initial treatment for postpartum endometritis typically includes which regimen?

• A. Oral antibiotics only
• B. Intravenous broad-spectrum antibiotics
• C. No antibiotics
• D. Surgical drainage

Answer: (B)

Postpartum endometritis is usually a polymicrobial infection of the uterine lining that can rapidly progress toward sepsis if not treated promptly. Because this infection involves organisms from the vaginal tract and often includes anaerobes, it requires aggressive therapy with broad-spectrum coverage to rapidly sterilize the endometrium and prevent systemic spread. Starting with intravenous antibiotics ensures high, reliable drug levels and quick clinical improvement, which is crucial in the acute postpartum setting. Regimens typically cover both aerobes and anaerobes and are designed for inpatient administration, with a transition to oral antibiotics later only after the patient stabilizes. Surgical drainage is not the initial step unless imaging shows an abscess or there is no response to antibiotics.