Prospective evaluation of combinations of antimicrobial agents for endometritis after cesarean section.

Two hundred and thirty-six women were studied for the development of endometritis following cesarean section. Cultures were taken of the amniotic fluid and endocervix through the internal os during the operative procedure. Of the 236 patients, clinical evidence of endometritis developed in 105. Positive cultures of the amniotic fluid or the endocervix, or both, were not helpful in predicting significant clinical infection. The patients with endometritis were treated with a combination of either clindamycin and gentamicin or cefazolin and gentamicin. All of the 54 patients, receiving clindamycin and gentamicin improved, but eight of the 51 patients in the cefazolin group failed to respond but, subsequently, improved after the administration of clindamycin. No serious toxicity was observed in either group.