Comparative Efficacy and Clinical Outcomes of Clindamycin-Gentamicin Versus Piperacillin-Tazobactam in Post-Cesarean Endomyometritis

Abstract

Background:
Postoperative endomyometritis remains a primary infectious and inflammatory complication of cesarean delivery, necessitating optimization of empirical antibacterial regimens.
Objectives: To evaluate the clinical efficacy, therapeutic safety, and clinical recovery markers of modern antibiotic regimens in the management of post-cesarean endomyometritis.
Materials and methods: We retrospectively analyzed clinical outcomes in 112 postpartum patients diagnosed with post-cesarean endomyometritis. Patients received combination antibiotic therapy: Group 1 (n = 58) received clindamycin plus gentamicin, and Group 2 (n = 54) received piperacillin/tazobactam. Time to fever defervescence, C-reactive protein (CRP) kinetics, requirement for treatment modification, and length of hospital stay were evaluated.
Results: Clinical resolution on initial antibiotic therapy was achieved in 84.5% of women in Group 1 and 90.7% in Group 2 (p = 0.332). Mean time to fever resolution was significantly shorter in Group 2 (38.6 ± 6.2 hours vs. 44.2 ± 8.5 hours; p = 0.028). Lochia cultures predominantly demonstrated polymicrobial growth (Escherichia coli, Enterococcus faecalis, Bacteroides spp.). Mean inpatient hospital stay was 6.4 ± 1.2 days. Severe systemic complications (sepsis, pelvic peritonitis) and surgical re-intervention were successfully prevented in 96.4% of patients.
Conclusions: Combination lincosamide-aminoglycoside therapy and broad-spectrum beta-lactamase inhibitor combinations exhibit high clinical efficacy in treating post-cesarean endomyometritis, with piperacillin/tazobactam providing faster fever resolution.

Keywords:
Cesarean Section, Endomyometritis, Antibacterial Therapy, Postpartum Infection, Clindamycin, Piperacillin-Tazobactam.