Chronic endometritis - a constantly discussed issue in infertile women.

OBJECTIVE: A review of current knowledge on the pathophysiology, diagnostic and treatment options for chronic endometritis in infertile women. METHODS AND RESULTS: One of the major causes of failed in vitro fertilization (IVF) is undiagnosed intrauterine pathologies, including chronic inflammation of the uterine mucosa - chronic endometritis. However, some authors relativize the negative impact of chronic endometritis on reproductive outcomes. The etiopathogenesis of chronic endometritis is due to qualitative and quantitative changes in the endometrial microbiome with abnormal multiplication of microorganisms naturally occurring in the uterine cavity or vagina. There is no uniform consensus on the most common pathogen causing chronic endometritis. It is characterized by infiltration of plasma cells into the endometrial stroma outside the menstrual cycle, accompanied by hyperaemia and endometrial oedema. Clinical symptoms are very mild or absent. The diagnosis of chronic endometritis is often difficult because there is no specific clinical or laboratory diagnostic method. The following investigative options are commonly used for the diagnosis of chronic endometritis: diagnostic hysteroscopy, histopathological examination of the endometrium including CD 138 immunohistochemistry and culture from the uterine cavity. However, standardised international hysteroscopic and histopathological criteria for accurate diagnosis of chronic endometritis are still lacking. Empirically administered antibiotic therapy improves the success rate of pregnancy and delivery of a viable foetus in infertile patients with proven chronic endometritis. In addition to reviewing the current knowledge of chronic endometritis, this article discusses the importance of hysteroscopy in the diagnostic process. CONCLUSION: Chronic endometritis is often a clinically silent disease with negative impact on reproduction in infertile women. Although there are still many unresolved issues, the introduction of hysteroscopy into the diagnostic process is important for clinical practice; however, hysteroscopy even in combination with histological examination of the endometrium, often does not allow an unequivocal diagnosis of chronic endometritis. Further prospective randomised studies in a selected group of women with proven chronic endometritis and repeated failure to implant proven euploid embryos should refine this knowledge.

Use of regenerative medicine in the treatment of endometritis in mares: A systematic review and meta-analysis.

Defining the optimal therapy for endometritis remains a significant challenge for clinicians. Given the public health threat posed by antibiotic resistance and the inconclusiveness of traditional therapies, regenerative medicine has been proposed as an alternative. The objective of this study was to conduct a comprehensive systematic review and meta-analysis, to investigate the efficacy of regenerative medicine products in the treatment of both post-breeding persistent and chronic degenerative endometritis (PBIE/CDE) in mares, following the PRISMA guidelines. This research could be a comprehensive scientific reference for determining appropriate treatments and clinical strategies. All studies exploring the use of regenerative medicine therapies (i.e., plasma products, autologous conditioned serum, mesenchymal stem cells MSCs, and MSC derivatives) in the treatment of PBIE/CDE were included, regardless of the specific protocol used, the evaluated outcomes, or the diagnostic method employed. Two authors independently gathered data and evaluated the risk of bias for each study. Treatment effects were assessed using risk ratios for dichotomous data, accompanied by 95 % confidence intervals. Data were aggregated utilizing the fixed-effects model. The quality of evidence for each outcome was evaluated using GRADE criteria. Eighteen studies were included in the systematic review, while fifteen trials were included in the meta-analysis. A sub-meta-analysis was conducted separately on platelet-derived products, as well as on MSCs and their derivatives. The results demonstrated an overall positive effect of regenerative therapies in treating PBIE/CDE, particularly those involving MSCs and their derivatives. The positive outcomes include an anti-inflammatory effect, characterized by reduced intrauterine fluid accumulation, neutrophils, and cytokine concentrations. Additionally, improvements in pregnancy, foaling, and embryo recovery rates have been observed in some cases. Despite the limited number of randomized controlled studies and the high variability among protocols, including the timing of treatment, type, and volume of products used, the use of regenerative products, especially MSCs and their derivatives, has promising results in terms of both efficacy and safety for treating PBIE/CDE in mares.

Antibiotics improve reproductive outcomes after frozen-thaw embryo transfer for chronic endometritis treatment, especially in those with repeated implantation failure.

PURPOSE: To investigate the impact of antibiotic treatment for chronic endometritis (CE) on the pregnancy outcome of frozen-thawed embryo transfer (FET) cycles and the relevant clinical risk factors associated with CE. METHODS: A retrospective cohort analysis was conducted on 1352 patients who underwent hysteroscopy and diagnostic curettage at Nanjing Maternal and Child Health Hospital from July 2020 to December 2021. All patients underwent CD138 immunohistochemical (IHC) testing to diagnose CE, and a subset of them underwent FET after hysteroscopy. Patient histories were collected, and reproductive prognosis was followed up. RESULTS: Out of 1088 patients, 443 (40.7%) were diagnosed with CE. Univariate and multivariate binary logistic regression analyses revealed that parity ≥ 2, a history of ectopic pregnancy, moderate-to-severe dysmenorrhea, hydrosalpinx, endometrial polyps, a history of ≥ 2 uterine operations, and RIF were significantly associated with an elevated risk of CE (P < 0.05). Analysis of the effect of CE on pregnancy outcomes in FET cycles after antibiotic treatment indicated that treated CE patients exhibited a significantly lower miscarriage rate (8.7%) and early miscarriage rate (2.9%) than untreated non-CE patients (20.2%, 16.8%). Moreover, the singleton live birth rate (45.5%) was significantly higher in treated CE patients than in untreated non-CE patients (32.7%). Survival analysis revealed a statistically significant difference in the first clinical pregnancy time between treated CE and untreated non-CE patients after hysteroscopy (P = 0.0019). Stratified analysis based on the presence of recurrent implantation failure (RIF) demonstrated that in the RIF group, treated CE patients were more likely to achieve clinical pregnancy than untreated non-CE patients (P = 0.0021). Among hysteroscopy-positive patients, no significant difference was noted in pregnancy outcomes between the treatment and control groups (P > 0.05). CONCLUSION: Infertile patients with a history of parity ≥ 2, hydrosalpinx, a history of ectopic pregnancy, moderate-to-severe dysmenorrhea, endometrial polyps, a history of ≥ 2 uterine operations, and RIF are at an increased risk of CE; these patients should be recommended to undergo hysteroscopy combined with CD138 examination before embryo transfer. Antibiotic treatment can improve the reproductive outcomes of FET in patients with CE, especially those with RIF.

Use of equine embryo -derived mesenchymal stromal cells and their extracellular vesicles as a treatment for persistent breeding-induced endometritis in susceptible mares.

Persistent breeding induced endometritis (PBIE) is a significant cause of infertility in mares. The development of a safe, universal, readily available therapeutic to manage PBIE and facilitate an optimal uterine environment for embryo development may improve pregnancy rates in susceptible mares. Mesenchymal stromal cells (MSCs) are being used increasingly as a therapeutic mediator for inflammatory conditions such as endometritis, and early gestational tissue provides a unique source of multipotent stem cells for creating MSCs. Extracellular vesicles (EVs) are mediators of cell communication produced by many different cell types. This study utilized embryo-derived mesenchymal stromal cells (EDMSCs) and their EVs as a potential therapeutic modality for PBIE in two groups: a) PBIE-susceptible mares challenged with pooled dead sperm (n=5); and b) client-owned mares diagnosed as susceptible to PBIE (n=37 mares and 40 estrous cycles). Mares pre-treated with intrauterine EDMSCs or their EVs resulted in a significant reduction in the accumulation of intrauterine fluid post-breeding. Nine of 19 (47 %) mares treated with EDMSCs prior to natural breeding and 13 of 20 (65 %) mares treated with EDMSC derived EVs were pregnant after the first cycle and 12 of 18 (67 %) mares treated with EDMSCs, and 15 of 19 (79 %) mares treated with EVs conceived by the end of the breeding season. These preliminary clinical studies are the first reports of the use of EDMSCs or their EVs as a potential intrauterine therapy for the management of PBIE susceptible mares.

Therapeutic effect of human umbilical cord mesenchymal stem cells and their conditioned medium on LPS-induced endometritis in mice.

AIM: To explore the effect of human umbilical cord mesenchymal stem cells (hUC-MSCs) and their conditioned medium (MSC-CM) in repairing the endometritis mouse model in vivo. METHODS: Lipopolysaccharide (LPS) was used to induce acute inflammation in endometritis mouse model. Mice were treated in six groups: control group (PBS), model group (LPS), LPS+MSC-CM (6 h) group, LPS+MSC-CM (12 h) group, LPS+MSCs (6 h) group and LPS+MSCs (12 h) group. Morphological and histological changes of mouse uterus were observed, and mouse uterine inflammation index myeloperoxidase (MPO) and related immune index TNF-α, IL-6 and IL-1ß levels were detected by ELISA. RESULTS: There exist remarkable inflammatory response and an obvious increase in the value of MPO, TNF-α, IL-1ß and IL-6 in the endometritis mouse model compared with the control group. Morphological and histological appearances were relieved after treated with hUC-MSCs and MSC-CM. Besides, the value of MPO, TNF-α, IL-1ß and IL-6 showed different degrees of decline. In comparison with LPS+MSC-CM (12 h) and LPS+MSCs (12 h) group, there was significant decrease in inflammatory indicators in LPS+MSC-CM (6 h) and LPS+MSCs (6 h) group. CONCLUSIONS: Intrauterine infusion of hUC-MSCs and MSC-CM can alleviate LPS induced endometritis.

Unveiling the protective effects of BMSCs/anti-miR-124-3p exosomes on LPS-induced endometrial injury.

Researchers have reported that miR-124-3p is highly expressed in patients with chronic endometritis. However, the underlying mechanism of miR-124-3p in the development of endometritis remains unclear. This study constructed an in vitro endometrial cell injury model by treating HEECs with 2 µg/mL LPS for 48 h. Then, 1 mg/kg LPS was injected into both sides of the mouse uterus to construct an in vivo endometrial injury model. The expression of miR-124-3p in human endometrial epithelial cells (HEECs) was assessed using RT‒qPCR. Exosomes were separated from bone marrow-derived mesenchymal stem cells (BMSCs) and cocultured with HEECs. A dual-luciferase reporter assay was performed to confirm the relationship between miR-124-3p and DUSP6. The results indicated that LPS inhibited HEEC viability in a time- and dose-dependent manner. The miR-124-3p inhibitor reversed the LPS-induced apoptosis and inhibition of HEEC viability. In addition, miR-124-3p could be transferred from BMSCs to HEECs by exosomes. Exosomes were derived from BMSCs treated with an NC inhibitor (BMSCs/NC Exo) or miR-124-3p inhibitor (BMSCs/anti-miR-124-3p Exo). In addition, BMSCs/anti-miR-124-3p Exo abolished the LPS-induced inhibition of HEEC viability and proliferation by inducing HEEC apoptosis. Moreover, BMSCs/anti-miR-124-3p Exo alleviated the LPS-induced inflammation of HEECs by upregulating DUSP6 and downregulating p-p65 and p-ERK. Furthermore, in an LPS-induced in vivo endometrial injury model, BMSCs/anti-miR-124-3p Exo increased the expression level of DUSP6 and decreased the expression levels of p-p65 and p-ERK. BMSCs/anti-miR-124-3p Exo protected against LPS-induced endometrial damage in vitro and in vivo by upregulating DUSP6 and downregulating p-p65 and p-ERK1/2. This study showed that BMSCs/anti-miR-124-3p Exo might be a potential alternative for the treatment of endometritis.

Inflammation in recurrent miscarriage - a comprehensive perspective from uterine microenvironment and immune cell imbalance to therapeutic strategies.

Recurrent miscarriage, poses a significant challenge for many couples globally, the causes of which are not fully understood. Recent studies have shown the intricate link between uterine inflammation and recurrent miscarriages. While inflammation is essential during early pregnancy stages, especially in embryo implantation, an imbalance can lead to miscarriage. Key inflammatory mediators and an imbalance in immune cells can significantly alter and contribute to recurrent miscarriages. Lifestyle factors like smoking and obesity exacerbate inflammatory responses, increasing miscarriage risks. Understanding the interaction between the uterine environment, immune cell imbalances, and recurrent miscarriages is essential for devising effective treatments. This paper presents the latest data on inflammation's role in recurrent miscarriage, emphasizing the significance of diagnosing chronic endometritis and immune imbalances, offering practical recommendations for treatment and diagnosis.

A influência da endometrite crônica nas pacientes com falhas de implantação recorrentes após fertilização in vitro / The influence of chronic endometritis in patients with recurrent implantation failure after in vitro fertilizatio

A endometrite crônica é um processo inflamatório persistente na camada endometrial, geralmente causada por invasão bacteriana. É uma afecção mal definida quanto a critérios de diagnósticos e tratamento. Devido à sua discreta sintomatologia, a real prevalência da endometrite crônica na população em geral não é conhecida, mas estima-se que esteja entre 0,8 e 19%. A aplicação de protocolos para rastreamento da endometrite crônica em mulheres com falha de implantação de embriões de boa qualidade após fertilização in vitro FIV é controversa. Alguns serviços utilizam a histeroscopia em todas as pacientes antes de iniciar o tratamento de reprodução assistida; entretanto, não há consenso de que a efetividade da histeroscopia melhore o prognóstico das mulheres inférteis. Os achados sugerem que o impacto da endometrite crônica na fertilidade e nos resultados da FIV precisam de futuras investigações em estudos prospectivos randomizados.

Chronic endometritis is a persistent inflammation of the endometrial lining usually caused by bacteria invasion. It is a non-well defined pathology difficult to both diagnosis and treatment. Because of its subtle nature, the real prevalence of chronic endometritis in the general population is ill defined, but is estimated between 0.8 and 19%. The implementation of protocols for screening of women, who have recurrent implantation failure after IVF with good quality embryo, is controversial, but some services have been using hysteroscopy in every patient immediately prior to FIV. However, there is no consensus on the effectiveness of hysteroscopy in improving the prognosis of infertile women. The findings suggest that the impact of chronic endometritis on fertility and outcomes should be further investigated in prospective randomized studies.

Tratamento da endometrite puerperal com antibioticoterapia parenteral exclusiva / Treatment of puerperal endometritis using a regimen with exclusive parenteral antibiotics

OBJETIVO: analisar a efetividade e segurança da antibioticoterapia parenteral hospitalar exclusiva para tratamento da endometrite puerperal, em população de baixo nível socioeconômico. MÉTODOS: estudo clínico prospectivo, que avaliou 21 puérperas com diagnóstico de endometrite puerperal, cujas gestações foram resolvidas em hospital universitário por cesárea (52,4 por cento) ou parto normal (47,6). A amostra caracterizou-se por baixo nível socioeconômico e de escolaridade. Foram submetidas ao regime de antibioticoterapia parenteral exclusiva, apenas durante o período de internação (grupo ATP-EX). Os resultados foram comparados com aqueles obtidos de série histórica do mesmo serviço (20 casos) submetidas a antibioticoterapia parenteral hospitalar, complementada por terapia via oral ambulatorial (grupo ATP+VO). As pacientes foram avaliadas clinicamente em retornos periódicos visando identificar casos de recidivas e complicações infecciosas. RESULTADOS: uma paciente do grupo ATP+VO necessitou de reinternação no 6º dia após a alta por recrudescência da endometrite. Não foi observada nenhuma complicação entre as pacientes do grupo ATP-EX. CONCLUSAO: para o tratamento de endometrite puerperal, não foi observado benefício adicional com a adição da antibioticoterapia oral complementar após a alta. Os resultados com o uso da antibioticoterapia parenteral exclusiva durante a internação indicam que esse esquema pode ser utilizado com segurança em população de baixo nível socioeconômico

Les infections de l'arbre génito-urinaire / The infections of the genito-urinary tree

Les infections génito-urinaires sont dominées, en terme de fréquence, par les cystites et les vaginites: ce sont des consultations quotidiennes qui permettent d'affiner progressivement notre connaissance de l'homéopathie à la lumière de l'efficacité des remèdes prescrits. (AU)

Infecciones genitales debidas a Chlamydia trachomatis / Genital infections caused by Chlamydia trachomatis

C. trachomatis es la bacteria más frecuentemente involucrada en la etiología de las enfermedades de transmisión sexual. En la mujer la cervicitis, que se puede complicar con endometritis, salpingitis e infertilidad, es la presentación clínica más común. Sin embargo, la mayoría de las infecciones genitales en la mujer son asintomáticas. En el hombre la uretritis y la epididimitis son formas frecuentes de presentación. El diagnóstico de las infecciones por C. trachomatis se puede hacer por métodos de detección de antígenos incluyendo la amplificación de los ácidos nucleicos. Dependiendo de la presentación clínica diversos protocolos de tratamiento se pueden implementar (AU)

Characterization of aerobic bacteria in the uterus and cervix of mares with suspected or clinical metritis

Quatrocentos e trinta éguas com metrite clínica ou suspeita foram examinadas clínica e bacteriologicamente quanto à análise comparativa entre o diagnóstico clínico e o sucesso na resposta bacteriológica. De 303 (70,4 por cento) éguas que mostraram contaminaçäo bacteriana, 172 (40 por cento) apresentaram organismos Gram negativos e 131 (30,4 por cento) bactérias Gram positivas, sendo a E. coli (n = 82), K. pneumoniae (n = 26), P. aeruginosa (n = 20), S. aureus (n = 19) e S. zooepidemicus (n = 18) os patógenos mais frequentes. Contra um conjunto de 18 agentes antimicrobianos, os microrganismos Gram-negativos mostraram resistência in vitro à maioria das drogas, enquanto que os Gram positivos (excluindo-se S. aureus e E. faecalis) foram todos sensíveis. Nitrofurantoína, sulfamethoxazol + trimethoprim e gentamicina foram os agentes de açäo antimicrobiana mais efetivos contra todas as bactérias

estudio clínico controlado aleatorio abierto de la eficacia y seguridad de "gentamicina-clindamicina" Vs. "pefloxacina-metronidazol" en el tratamiento de la endometritis post-cesárea

Con el fin de comparar la eficacia y seguridad de dos regímenes terapéuticos(clindamicina-gentamicina y pefloxacina-metronidazol) en el tratamiento de la endometritis post-cesárea, se incluyeron 71 pacientes que fueron sometidas a parto abdominal de urgencia en el Instituto Materno Infantil del 1§ de septiembre de 1993 al 31 de agosto de 1994 y que se presentaron endometritis post-cesárea diagnosticada por la presencia de tres de nueve criterios utilizados en el Servicio de Sépticas. Se asignaron de manera aleatoria de manera a uno de los dos grupos de tratamiento: gentaicina-clindamicina o metronidazol-pefloxacina. Se estudió la eficacia terapéutica mediante la comparación del tiempo de desaparición de la fiebre, la evolución clínica, los fracasos terapéuticos y las complicaciones. También se evaluó la seguridad de los dos regímenes. Se aplicó la prueba t de student y Chi cuadrado para significación estadística(a=0.05). Resultados: La seguridad se determinó en 68 pacientes que asistieron al control el día 5 de tratamiento y la eficacia en 63 pacientes que asistieron al control del día 7. Los cultivos de endometrio mostraron gérmenes anaerobios en el 48 por ciento de las pacientes y se aislaron en promedio 1.9 gérmenes por paciente. No hubo diferencias entre los dos grupos de tratamiento en cuanto a desaparición de la fiebre(p=0.82), tasa de mejoría (p=0.49), complicaciones (p=0.44). La sensibilidad antibiótica de los gérmenes aerobios fue alta para los antibióticos utilizados y no se encontró b lactamasa en los cuatro casos en los que se aislo N. gonorrohae. Conclusiones: La asociación clindamicina-gentamicina fue tan eficaz como la asociación pefloxacina-metronidazol en el tratamiento de la endometritis post-cesárea por lo que ésta última asociación se podría tener como una alternativa terapéutica

Infección puerperal

A pesar del conocimiento amplio de la morbilidad materna infecciosa, así como el uso frecuente de antimicrobianos profilácticos para disminuir la incidencia de endometriosis, dicha infección sigue siendo potencialmente complicación grave del parto. La infección pélvica posparto ha recibido muchos nombres a saber, endometritis, metritis, endometriosis y endomioparametris. De ellos, el más utilizado es el de endometriosis, para referirnos a la infección intrauterina posparto. El diagnostico se sospecha cuando una mujer posparto presenta fiebre en ausencia de otros sitios obvios de infección.

Experiencia del manejo de la endometritis en el Instituto Nacional de Perinatología (INPer) / Experience with management of endometritis at Instituto Nacional de Perinatología (INPer) Mexico

Le endometritis es la complicación infecciosa más frecuente del puerperio. Con la finalidad de conocer las características clínicas, etiología y evolución de éste padecimiento, se realizó un estudio retrospectivo de las pacientes que desarrollaron endometritis en el Instituto Nacional de Perinatología (INPer) en el periodo comprendido del 1o. de enero de 1990 al 31 de mayo de 1991. En los 17 meses de revisión se diagnosticaron 120 casos, de los cuales se pudo revisar el expediente de 90 En. 90 por ciento de las pacientes la vía de resolución del embarazo fue la cesárea; un 24.4 por ciento tuvo antecedente de ruptura prematura de membranas. En 10 por ciento se diagnosticó corioamnioitis. El periodo de latencia para el desarrollo de endometritis postparto fue de 120 +/- 66 horas, mientras que en los casos postcesárea fue de 56 +/- 30 horas (p= 0.001). Los síntomas más frecuentes fueron fiebre (100 por ciento), loquisfétidos (61.1 por ciento) y dolor a la movilización uterina (60 por ciento). La infección fue de tipo polimicrobiano, las bacterias más frecuentemente aisladas fueron: Staphylococcus coagulasa negativo, Escherichia coli y Peptostreptococcus. Un 3.3 por ciento desarrolló pelviperitonitis; una paciente falleció.

Metrite em cadelas: uma opcao de tratamento seguro e sem cirurgia, com med. hom / Metritis in bitches: an option of secure treatment without surgery, with hom. med

Este trabalho teve como objetivo nao tratar atraves de cirurgia a metrite em cadelas. Embora outros tratamentos estejam sendo tentados, o tratamento cirurgico e o de eleicao nest patologia. Os tratamentos testados ate agora possuem alguns inconvenientes. Sao de custo elevado, tem varios efeitos colaterais que obrigam os animais a serem hospitalizados durante parte do tratamento e seus resultados, ainda estao sendo avaliados. Durante cinco anos de rotina clinica usando os medicamentos homeopaticos alguns animais foram tratados de metrite. Destes foram descritos dois casos considerados bastante ilustrativos. Os animais eram identificados com fichas individuais que continham sua resenha e dados do proprietario. A data de cada retorno era anotada assim como as melhoras, pioras e medicamentos utilizados durante o tratamento

Metrite em cadelas: uma opcao de tratamento seguro e sem cirurgia com os medicamentos homeopaticos / Metrite in female dogs: a secure treatment and without surgery with homeopathic drugs

Na tentativa de nao usar o tratamento cirurgico devido aos riscos ou outros, cujos efeitos colaterais e custos mais elevados sao fatores importantes a serem considerados, foi realizado o tratamento homeopatico. Durante os cinco anos de experiencia clinica com os medicamentos homeopaticos alguns animais foram tratados para metrite. Destes foram descritos dois casos considerados bastante ilustrativos. O caso 1 foi uma cadela de raca Doberman com dois anos e meio de idade. O caso 2 foi o de uma femea mestica de pequines com 15 anos de idade, nesta a metrite estava associada a sintomas de pseudociese (gravidez psicologica). No caso 1 foram utilizados durante o tratamento os seguintes medicamentos: Caulophylum 2a., Secale 3a., Hepar sulphur 30a., Hamamelis 5a., Lachesis 30a., Arnica montana 30a. O tratamento durou um periodo de onze meses, pois teve duas recidivas. Uma recidiva quatro meses apos o primeiro tratamento e outra apos o parto normal que ocorreu seis meses apos esta. Apos o ultimo tratamento (pos-parto) o animal nao mais cruzou e nao teve mais disturbios ligados ao aparelho reprodutor ate o seu obito ocorrido tres anos apos devido provavelmente a uma intoxicacao. Os medicamentos homeopaticos usados no caso 2 foram Pulsatilla 200a. e Pulsatilla 30a., Ipeca 5a., Hamamelis 5a., Belladona 5a. e Asafoetida 4x. Houve desaparecimento total dos sintomas. A experiencia clinica concorda com os achados de literatura. Segundo Wolff, H.G. (1985) "A piometra em cadelas oferece uma excelente ilustracao dos valiosos servicos que a Homeopatia e capaz de prestar"

Tratamiento de la endometritis postcesárea y postparto. Comparación de dos esquemas: pefloxacina vs ampicilinia gentamicina / Treatment of endometriosis post-cesarean section and post-partum. Comparison of two schemes: Pefloxacin vs ampicillin-gentamicyn

La pefloxacina es un antibiótico del grupo de las quinolonas, que ha sido empleado en infecciones sistémicas con altas tasas de curación. Su utilidad en diversas enfermedades de transmisión sexual ya ha sido demostrada. Sin embargo, no se conoce de su uso en la endometritis postcesárea (EMPC) y postparto (EMPP), por lo cual se decidió conocer su seguridad y eficacia en este tipo de infecciones. Se estudiaron 30 pacientes con diagnóstico de endometritis postcesárea o postparto. A todas se les tomó cultivo de endometrio con catéter de triple luz y tres hemocultivos para aerobios. Las pacientes se dividieron en dos grupos de 15 pacientes cada una. El primer grupo, recibió pefloxacina y el segundo ampicilina más gentamicina. Los antibióticos se administraron por vía intravenosa hasta que las pacientes cursaron 24 horas afebriles cambiándose enseguida la vía oral o IM, la edad promedio fue de 25 años. Veinticinco casos correspondieron a EMPC y cinco casos a EMPP. Ninguna recibió antibióticos profilácticos. Hubo una sola falla terapeútica en el grupo II con aislamiento de Pseudomonas sp. Dos pacientes del grupo I manifestaron efectos colaterales (náuseas, vómito, parestesias). Ambos grupos recibieron siete días de tratamiento como promedio. Hubo dos pacientes complicadas con absceso de pared en el grupo I. Escherichia coli, Gardnerella vaginalis y Staphylococcus coagulasa negativo fueron aislamientos más frecuentes. No se determinó significancia estadística al comparar ambos tratamientos, concluyéndose que la pefloxacina es una nueva opción terapéutica en el manejo de endometritis.