Rosh Emergency Medicine Practice Test

In a patient 4 days post-cesarean delivery with lower abdominal pain and fever, what is the best next step for suspected postpartum infection?

1. Consultation with OB/GYN for dilation and curettage

2. IV ceftriaxone and oral doxycycline

3. IV access and IV gentamicin and clindamycin

4. Oral doxycycline and cefotetan

The correct answer is: IV access and IV gentamicin and clindamycin

In the case of a patient presenting with lower abdominal pain and fever just four days after a cesarean delivery, the suspicion for a postpartum infection is high, particularly for endometritis. The best next step involves not only addressing the potential infection but also considering the most effective antibiotic coverage. Selecting intravenous access and initiating treatment with gentamicin and clindamycin provides broad-spectrum coverage against the likely pathogens involved in postpartum infections, which include anaerobes and gram-negative organisms. Clindamycin is particularly effective against anaerobic bacteria, which are commonly found in the uterine flora and can contribute to endometritis. Gentamicin covers gram-negative organisms, offering a comprehensive approach to treat the infection that may arise post-cesarean section. While other options also present antibiotic regimens, they may lack certain aspects of broad-spectrum coverage or are not the first-line treatments in these situational contexts. For instance, some regimens may rely on oral administration or are intended for different specific scenarios, which could delay proper treatment for a potentially severe infection. Therefore, the combination of IV gentamicin and clindamycin is the most effective and appropriate choice for rapid intervention in the face of suspected postpartum infection.