Question

A 23 year-old G1P1 delivered vaginally and sustained a 2nd-degree laceration. She had a prolonged first stage of labor, ruptured membranes for 26 hours and received penicillin for group B Strep prophylaxis. She now complains of increasing abdominal pain, cramping and heavy foul smelling lochia. Her vital signs reveal a temperature of 100.0° F, 37.8° C; pulse 80; blood pressure 120/60; and respirations 18. She has a tender uterine fundus that measures at the umbilicus. Her extremities reveal mild bilateral edema; no erythema or tenderness. Blood work reveals a white count of 12.2; hematocrit of 34. Which antibiotic would be most appropriate for this patient?

1) Erythromycin
2) Gentamicin
3) Doxycycline
4) Vancomycin
5) Ciprofloxacin

Answer 1

The most appropriate treatment for a postpartum patient with symptoms of endometritis, according to the options provided, would be Gentamicin, but clinical practice typically involves combination therapy, possibly with Clindamycin or ampicillin. Vancomycin would be used if MRSA was suspected or confirmed.

Step-by-step explanation:

The most appropriate antibiotic for a 23-year-old G1P1 who recently delivered vaginally, sustained a 2nd-degree laceration, and is now presenting with symptoms suggestive of postpartum endometritis (increasing abdominal pain, cramping, heavy foul-smelling lochia, tender uterine fundus) would likely be Gentamicin in combination with Clindamycin or ampicillin. While this specific question only lists one choice of antibiotic, in a clinical setting, combination therapy is generally preferred to cover the broad range of possible pathogens involved in postpartum infections, which may include aerobic and anaerobic bacteria. The elevated white blood cell count and the patient's symptoms suggest an infection. The choice of antibiotics in a clinical case would be guided by the patient's specific situation, any known allergies, local antibiotic resistance patterns, and ideally, the results of culture and sensitivity testing. Vancomycin would be reserved for cases suspected or confirmed to be due to methicillin-resistant Staphylococcus aureus (MRSA), and this situation does not specifically suggest MRSA infection.