Abstract
Objective: Ampicillin plus sulbactam, an irreversible β-lactamase inhibitor, was compared to cefoxitin in the treatment of women with acute pelvic inflammatory disease (PID) with and without inflammatory mass(es).
Methods: Participation in an open, prospective, randomized clinical trial was offered to all women given the clinical diagnosis of acute PID who required inpatient therapy. Neisseria gonorrhoeae and Chlamydia trachomatis were sought in cervical and endometrial samples and aerobic and anaerobic species were sought in endometrial samples prior to treatment initiation. Treatment was given on at least 4 days and until women were afebrile for at least 48 h. Daily examinations were performed to assess response to therapy and safety. Only women in whom C. trachomatis was identified were discharged from the hospital on oral doxycycline to be taken for 10–14 days.
Results: One hundred twenty-four women were evaluated for safety; 117 (94%) were evaluated for efficacy. Demographic characteristics were similar for women in each treatment group. N. gonorrhoeae was recovered from 59% and C. trachomatis was recovered from 42% of study subjects. Inflammatory masses were identified in 35/76 (46%) women given ampicillin/sulbactam and 17/41 (41%) women given cefoxitin. Ampicillin/sulbactam cured 75 ,of 76 women (98.7%) [95% confidence interval (CI) 92.9–100.0%] and cefoxitin cured 37 of,41,omen (90.2%) (95% CI 76.9–97.3%) in that treatment regimen.
Conclusions: Overall ampicillin/sulbactam was more effective (P = 0.05) than cefoxitin, due to superior efficacy in infection complicated by inflammatory mass(es).35/35 vs. 12/17 cured; P = 0.007).
Full Text
The Full Text of this article is available as a PDF (603.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Centers for Disease Control (CDC) Sexually transmitted diseases treatment guidelines 1982. MMWR Morb Mortal Wkly Rep. 1982 Aug 20;31 (Suppl 2):33S–60S. [PubMed] [Google Scholar]
- Cumming D. C., Honoré L. H., Scott J. Z., Williams K. E. Microscopic evidence of silent inflammation in grossly normal fallopian tubes with ectopic pregnancy. Int J Fertil. 1988 Sep-Oct;33(5):324–328. [PubMed] [Google Scholar]
- Gershman K. A., Rolfs R. T. Diverging gonorrhea and syphilis trends in the 1980s: are they real? Am J Public Health. 1991 Oct;81(10):1263–1267. doi: 10.2105/ajph.81.10.1263. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hadgu A., Westrom L., Brooks C. A., Reynolds G. H., Thompson S. E. Predicting acute pelvic inflammatory disease: a multivariate analysis. Am J Obstet Gynecol. 1986 Nov;155(5):954–960. doi: 10.1016/0002-9378(86)90324-8. [DOI] [PubMed] [Google Scholar]
- Hager W. D., Eschenbach D. A., Spence M. R., Sweet R. L. Criteria for diagnosis and grading of salpingitis. Obstet Gynecol. 1983 Jan;61(1):113–114. [PubMed] [Google Scholar]
- Hemsell D. L., Hemsell P. G., Heard M. C., Nobles B. J. Piperacillin and a combination of clindamycin and gentamicin for the treatment of hospital and community acquired acute pelvic infections including pelvic abscess. Surg Gynecol Obstet. 1987 Sep;165(3):223–229. [PubMed] [Google Scholar]
- Hemsell D. L., Nobles B. J., Heard M. C., Hemsell P. G. Upper and lower reproductive tract bacteria in 126 women with acute pelvic inflammatory disease. Microbial susceptibility and clinical response to four therapeutic regimens. J Reprod Med. 1988 Oct;33(10):799–805. [PubMed] [Google Scholar]
- Hemsell D. L., Santos-Ramos R., Cunningham F. G., Nobles B. J., Hemsell P. G. Cefotaxime treatment for women with community-acquired pelvic abscesses. Am J Obstet Gynecol. 1985 Mar 15;151(6):771–777. doi: 10.1016/0002-9378(85)90517-4. [DOI] [PubMed] [Google Scholar]
- Hemsell D. L., Wendel G. D., Gall S. A., Newton E. R., Gibbs R. S., Knuppel R. A., Lane T. W., Sweet R. L. Multicenter comparison of cefotetan and cefoxitin in the treatment of acute obstetric and gynecologic infections. Am J Obstet Gynecol. 1988 Mar;158(3 Pt 2):722–727. doi: 10.1016/s0002-9378(16)44535-7. [DOI] [PubMed] [Google Scholar]
- Jacobson L., Weström L. Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy. Am J Obstet Gynecol. 1969 Dec 1;105(7):1088–1098. doi: 10.1016/0002-9378(69)90132-x. [DOI] [PubMed] [Google Scholar]
- Kosseim M., Ronald A., Plummer F. A., D'Costa L., Brunham R. C. Treatment of acute pelvic inflammatory disease in the ambulatory setting: trial of cefoxitin and doxycycline versus ampicillin-sulbactam. Antimicrob Agents Chemother. 1991 Aug;35(8):1651–1656. doi: 10.1128/aac.35.8.1651. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Peterson H. B., Walker C. K., Kahn J. G., Washington A. E., Eschenbach D. A., Faro S. Pelvic inflammatory disease. Key treatment issues and options. JAMA. 1991 Nov 13;266(18):2605–2611. doi: 10.1001/jama.266.18.2605. [DOI] [PubMed] [Google Scholar]
- Sellors J., Mahony J., Goldsmith C., Rath D., Mander R., Hunter B., Taylor C., Groves D., Richardson H., Chernesky M. The accuracy of clinical findings and laparoscopy in pelvic inflammatory disease. Am J Obstet Gynecol. 1991 Jan;164(1 Pt 1):113–120. doi: 10.1016/0002-9378(91)90639-9. [DOI] [PubMed] [Google Scholar]
- Sweet R. L., Schachter J., Robbie M. O. Failure of beta-lactam antibiotics to eradicate Chlamydia trachomatis in the endometrium despite apparent clinical cure of acute salpingitis. JAMA. 1983 Nov 18;250(19):2641–2645. [PubMed] [Google Scholar]