Meaney-Delman Dana, Bartlett Linda A, Gravett Michael G, Jamieson Denise J
National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; Johns Hopkins School of Public Health, Baltimore, Maryland; and the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), An Initiative of Seattle Children's, Seattle, Washington.
Obstet Gynecol. 2015 Apr;125(4):789-800. doi: 10.1097/AOG.0000000000000732.
To suggest options for oral and intramuscular antibiotic treatment of early postpartum endometritis in low-resource community settings where intravenous antibiotics are unavailable.
Studies were identified through MEDLINE from inception through December 2014. Search terms included [("anti-bacterial agents [MeSH]" or "anti-infective agents [MeSH]") and ("endometritis [MeSH]" or "puerperal infection [MeSH]")]. A second search using the terms [("endometritis or endomyometritis or puerperal infection) and ("antibiotics or antimicrobials or anti-bacterial agents or anti-infective agents)"] was also used. Additionally, all references from selected articles were reviewed, a hand-search of a subject matter expert library was conducted, and a search of ClinicalTrials.gov was performed.
We conducted a systematic review of the literature in two phases. Phase I provides a summary of clinical cure data from prospective studies of oral and intramuscular antimicrobial regimens as well as summarizes evidence from trials of intravenous antimicrobials. Phase II is a quantitative analysis of pathogens from intrauterine postpartum endometritis samples. Based on these results, and with consideration of existing recommendations for antibiotic use during breastfeeding, we suggest oral and intramuscular antimicrobial options for the treatment of early postpartum endometritis after vaginal delivery in low-resource settings.
TABULATION, INTEGRATION, AND RESULTS: Reports involving oral or intramuscular antimicrobial treatment of postpartum endometritis are rare and of generally poor quality. Antimicrobial trials of postpartum endometritis treatment and intrauterine microbiology studies suggest five antimicrobial regimens may be effective: oral clindamycin plus intramuscular gentamicin, oral amoxicillin-clavulanate, intramuscular cefotetan, intramuscular meropenem or imipenem-cilastatin, and oral amoxicillin in combination with oral metronidazole.
This review provides suggestions for oral, intramuscular, and combined antimicrobial regimens that may warrant additional study. Experimental trials should consider clinical effectiveness, safety and side effects profiles, and feasibility of community-based treatment.
针对资源匮乏的社区环境中无法获得静脉用抗生素的情况，提出产后早期子宫内膜炎的口服及肌内注射抗生素治疗方案。
通过MEDLINE检索从建库至2014年12月的研究。检索词包括[（“抗菌药[医学主题词]”或“抗感染药[医学主题词]”）以及（“子宫内膜炎[医学主题词]”或“产褥感染[医学主题词]”）]。还使用了另一检索词[（“子宫内膜炎或子宫肌层炎或产褥感染”）以及（“抗生素或抗菌剂或抗菌药或抗感染药”）]。此外，对所选文章的所有参考文献进行了回顾，对手头资料专家库进行了手工检索，并对ClinicalTrials.gov进行了检索。
我们分两个阶段对文献进行了系统评价。第一阶段总结了口服和肌内注射抗菌方案前瞻性研究的临床治愈数据，并总结了静脉用抗菌药物试验的证据。第二阶段是对产后子宫内子宫内膜炎样本中的病原体进行定量分析。基于这些结果，并考虑到母乳喂养期间抗生素使用的现有建议，我们提出了资源匮乏地区阴道分娩后早期产后子宫内膜炎的口服和肌内注射抗菌治疗方案。
制表、整合与结果：涉及产后子宫内膜炎口服或肌内注射抗菌治疗的报告很少，且质量普遍较差。产后子宫内膜炎治疗的抗菌试验和子宫内微生物学研究表明，五种抗菌方案可能有效：口服克林霉素加肌内注射庆大霉素、口服阿莫西林-克拉维酸、肌内注射头孢替坦、肌内注射美罗培南或亚胺培南-西司他丁，以及口服阿莫西林联合口服甲硝唑。
本综述为口服、肌内注射及联合抗菌方案提供了建议，这些方案可能值得进一步研究。实验性试验应考虑临床有效性、安全性和副作用情况以及社区治疗的可行性。
