cefotaxime and Endometritis

A prospective, randomized clinical trial was conducted to compare the efficacy and tolerance of a single dose of 1 g ceftriaxone i.v. daily with 3 doses of 1 g cefotaxime i.v. daily for obstetric and gynecologic infections. Both agents are characterized by a wide spectrum and potent activity. Furthermore, ceftriaxone has an outstanding serum half-life of 8 h. 41 patients with pelvic inflammatory disease, pelvic or wound infections after vaginal or abdominal hysterectomy, endomyometritis and urinary-tract infection were included. Patients were monitored clinically by routine laboratory methods (erythrocyte sedimentation rate, white blood cell count and cross-reacting protein) and bacteriologically. Clinical parameters of infection were fever, local pain and/or tenderness, a sactosalpinx or pyosalpinx at palpation and cervical secretion. Clinical cure was achieved in 77.3% in the ceftriaxone and in 78.9% in the cefotaxime group, improvement in 3 (13.6%) and 4 patients (21.0%), respectively. 2 clinical failures were seen in the ceftriaxone group. One was a severe pelvic infection following vaginal hysterectomy, which responded to the addition of metronidazole, the other was due to a chlamydial salpingitis, which was cured with a 10-day course of doxycycline. Both antibiotics were well tolerated. Our results suggest that for obstetric and gynecologic infections a single 1-gram dose of ceftriaxone is equally effective as three 1-gram doses of cefotaxime.

Topics: Cefotaxime; Ceftriaxone; Endometritis; Escherichia coli Infections; Female; Humans; Hysterectomy; Pelvic Inflammatory Disease; Prospective Studies; Randomized Controlled Trials as Topic; Surgical Wound Infection

To compare the efficacy of antibiotic prophylaxis through uterine lavage in women undergoing cesarean section in labor to the efficacy of the more standard, perioperative intravenous method, we prospectively randomized 100 women to receive either 2 g of cefotaxime in 1,000 mL of normal saline with a lavage protocol or 1 g of cefotaxime intravenously after cord clamping followed by 1-g doses 6 and 12 hours later. The two groups were similar with respect to age, gestational age, race, weight, length of labor and of ruptured membranes, use of internal monitoring, blood loss and number of vaginal examinations. Standard febrile morbidity and postpartum endomyometritis requiring antibiotic therapy occurred in 18% and 12%, respectively, of the lavage group and in 16% and 12%, respectively, of the intravenous group. Before the routine use of prophylactic antibiotics for cesarean section in labor on our service, the febrile morbidity and endomyometritis rates were 36% and 32%, respectively. The results confirm the benefit of prophylactic antibiotics for cesarean section in labor and demonstrate that the lavage and intravenous methods are similar with respect to efficacy.

Topics: Adult; Cefotaxime; Cesarean Section; Endometritis; Female; Humans; Injections, Intravenous; Labor, Obstetric; Pregnancy; Premedication; Therapeutic Irrigation; Uterus

A prospective randomized study was undertaken in 100 patients undergoing cesarean section to evaluate the efficacy of cefotaxime when given as a single-dose versus the more traditional triple-dose regimen for prophylaxis. Analysis of the results demonstrated no significant differences in febrile morbidity (14 versus 20%) or postoperative endometritis (10 versus 14%) between the single- and triple-dose groups, respectively. Pretherapy aerobic and anaerobic placental cultures were positive in 60% of the overall study population. In those patients who subsequently developed endometritis, seven (58%) had a positive placental culture, suggesting that this technique is relatively nonspecific as a screening procedure. Results of transcervical culture in the endometritis patients most often demonstrated a polymicrobial picture. Several of the organisms cultured were found to be resistant to cefotaxime, supporting the need to better guide antimicrobial therapy by routine endometrial culturing in patients who fail prophylaxis. The results of the present study suggest that single-dose administration of cefotaxime is equally effective as triple-dose therapy in reducing postcesarean section endometritis.

Topics: Adult; Bacterial Infections; Cefotaxime; Cesarean Section; Clinical Trials as Topic; Drug Administration Schedule; Drug Resistance, Microbial; Endometritis; Female; Humans; Pregnancy; Premedication; Prospective Studies; Random Allocation

Topics: Abscess; Adult; Aged; Amoxicillin; Breast Diseases; Cefotaxime; Ceftriaxone; Clinical Trials as Topic; Doxycycline; Drug Combinations; Endometritis; Erythromycin; Female; Genital Diseases, Female; Humans; Metronidazole; Middle Aged; Postoperative Complications; Pregnancy; Puerperal Infection; Salpingitis; Urinary Tract Infections

Forty-six females with pelvic soft tissue infections (recurrent salpingitis [n = 14], salpingitis with intrauterine contraceptive device [IUD] [n = 9], salpingitis with adnexal mass [n = 14], post-partum endomyoparametritis [n = 9]) were randomized for three antibiotic treatment regimens: cefotaxime (CTX) (n = 23), clindamycin and gentamicin (C + Gen) (n = 13), and clindamycin, gentamicin and penicillin (C + Gen + P) (n = 10). Patients were evaluated by diagnosis for clinical response to the three regimens and by pre-treatment bacterial susceptibility to the individual as well as the combination antibiotics. All 14 recurrent salpingitis patients responded satisfactorily to the assigned antibiotic regimen (CTX, n = 8; C + Gen, n = 3; C + Gen + P, n = 3). One of four patients with the diagnosis of salpingitis/IUD treated with CTX was a treatment failure, while three of three patients treated with C + Gen and two of two patients with C + Gen + P responded satisfactorily. Two of three patients with the diagnosis of salpingitis/adnexal mass failed therapy with C + Gen while the seven patients treated with CTX and the four patients with C + Gen + P responded satisfactorily. All nine patients with endomyoparametritis responded to their treatment regimen. Overall, there were no statistically significant differences in the responses by diagnosis and regimen, with the exception that C + Gen was significantly different (p less than 0.05) from CTX and C + Gen + P for the treatment of salpingitis with mass. Of the 141 bacterial isolates in all groups, 57 were aerobic or anaerobic gram-positive organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Cefotaxime; Endometritis; Enterococcus faecalis; Female; Humans; Microbial Sensitivity Tests; Neisseria gonorrhoeae; Salpingitis

One hundred eighteen women who developed endomyometritis after cesarean section in Parkland Memorial Hospital were treated with parenteral cefotaxime sodium. The requirement for additional antimicrobial therapy was significantly higher at an initial daily dose of 3 g/day (16.4%) than when the dose was 6 g/day (4.8%) (P less than .05). The latter clinical efficacy and the observed in vitro susceptibility of 88% of isolates indicate that cefotaxime is well suited for single-agent parenteral therapy for this polymicrobial pelvic infection. Subsequently, 120 women with the same diagnosis were randomly treated with cefotaxime or clindamycin and gentamicin. Patient populations, surgical variables, in vitro microbiologic data, and side effects were similar for both groups. Clinical success observed was also similar: it was 97.5% for women given cefotaxime and 95% for women given clindamycin and gentamicin.

Topics: Adult; Cefotaxime; Cesarean Section; Clindamycin; Endometritis; Female; Gentamicins; Humans; Pregnancy

Clinical efficacy of cefodizime (CDZM) in obstetric and gynecologic infections and in their prevention, and fluctuations in cervical mucus elastase in gynecologic infections and during pregnancy were studied, and the following results were obtained: 1. Cervical mucus elastase showed high values of > or = 5,001 micrograms/L in 68.2% of non-pregnant patients and in 25.9% of pregnant patients (gestational age of 24-42 weeks). Patients with concomitant chorioamnionitis showed a significantly higher rate of elastase elevation than those without this complication (63.2% vs. 25.9%, P < 0.005). 2. Cervical mucus elastase in uterine and pelvic infections showed high values before administration of CDZM but tended to decline with the progress of cure (15/19 cases, 78.9%). 3. The efficacy rate of 2-4 g/day of CDZM drip infusion against infections was 53/56 (94.6%) while the bacterial eradication rate was 36/38 (94.7%). The efficacy rate of 2 g/day of CDZM drip infusion for the prevention of postoperative infections was 429/431 (99.8%). Diarrhea occurred in 3/489 (0.6%) as subjective and objective side effects. Slight rises in GOT and GPT were noted in 13/486 (2.7%) as abnormal laboratory values. These results suggested the usefulness of CDZM in the obstetric and gynecologic fields.

Topics: Cefotaxime; Cervix Mucus; Drug Evaluation; Endometritis; Female; Humans; Pancreatic Elastase; Postoperative Complications; Pregnancy; Pregnancy Complications, Infectious; Premedication; Uterine Cervicitis

Cefmenoxime, a new third-generation cephalosporin, was used as a single drug in the therapy for female genital tract infections. Therapeutic response was considered satisfactory in 21 of 22 cases of pelvic inflammatory disease, six of nine tuboovarian abscesses, two of three severe wound infections, and all five cases of endometritis. Overall, 34 of 39 patients responded. The peak serum antibiotic levels in this study ranged from 15.8 to 64 (average 48.7) micrograms/mL, and the trough level ranged from 0.9 to 4 (average 3.1) micrograms/mL. Cefmenoxime was tested in vitro against 424 isolates of anaerobes including 208 strains of bacteroides of which 80 were Bacteroides fragilis. Cefmenoxime inhibited the growth of 90% or greater of the organisms (minimal inhibitory concentration 90) at less than or equal to 64 micrograms/mL. The minimal inhibitory concentration for 75% of B fragilis was 32 micrograms/mL. This study suggests that cefmenoxime as a single-drug therapy is effective in the treatment of female genital tract infections caused by aerobic (including the gonococcus) and anaerobic bacteria.

Topics: Abscess; Bacterial Infections; Cefmenoxime; Cefotaxime; Endometritis; Fallopian Tubes; Female; Genital Diseases, Female; Humans; Microbial Sensitivity Tests; Ovarian Diseases; Pelvic Inflammatory Disease; Pregnancy; Puerperal Infection; Surgical Wound Infection

New third generation cephalosporins have been recommended as single agent antibiotic therapy in the treatment of postoperative infections. This study compares the new third generation cephalosporin ceftizoxime with cefoxitin, clindamycin and gentamicin in the treatment of postcesarean section endomyometritis. The results indicate that the clindamycin and gentamicin regimen is more efficacious in the treatment of severe infection after cesarean section than either ceftizoxime or cefoxitin regimens. Therefore, the results of this study suggest caution in substituting single drug antibiotic therapy with cefoxitin or the third generation cephalosporins for the standard clindamycin and gentamicin regimen in the treatment of postcesarean section endomyometritis until more clinical data are available.

Topics: Adult; Cefotaxime; Cefoxitin; Ceftizoxime; Cervix Uteri; Cesarean Section; Clindamycin; Drug Therapy, Combination; Endometritis; Escherichia coli; Female; Gentamicins; Humans; Postoperative Complications; Pregnancy; Streptococcus agalactiae; Streptococcus pyogenes

Ceftriaxone (Ro 13-9904, CTRX) was administered to 3 cases with gynecological infections and following results were obtained. CTRX was administered by intravenous drip infusion or intravenous injection with 2 g per day for 4 to 6 days. The clinical efficacy was good in all cases (2 cases with pyometra, 1 case with adnexitis and endometritis). No side effect could be determined in all cases.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Endometritis; Female; Humans; Infusions, Parenteral; Injections, Intravenous; Middle Aged; Pelvic Inflammatory Disease; Suppuration; Uterine Diseases

Ceftriaxone (Ro 13-9904, CTRX), a newly developed parenteral cephalosporin antibiotic was clinically evaluated in gynecoobstetric infections and the following results were obtained. CTRX was administered by intravenous drip infusion twice a day in a daily dose of 2 to 4 g to 10 cases with gynecoobstetric infections, consisting of 8 with intrauterine infections, 1 with adnexitis and 1 with infection of external genitalia. The global clinical efficacy was excellent in 2 and good in 6 out of 8 cases with intrauterine infections, and in 2 others, the efficacy rate being 100%. Bacteriologically, the eradication of bacteria was observed in 5, unchange in 2 and alternation of bacteria in 2 among 9 cases where the causative strains were detected. Neither adverse reaction nor laboratory test abnormality was observed. The above-mentioned results suggest that CTRX is a highly safe antibiotic expected to be excellent in the clinical efficacy and bacteriological effects.

Topics: Adult; Aged; Bacterial Infections; Cefotaxime; Ceftriaxone; Endometritis; Female; Humans; Infusions, Parenteral; Middle Aged; Pelvic Inflammatory Disease; Pregnancy; Puerperal Infection; Uterine Diseases

Topics: Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cefotaxime; Endometritis; Female; Horse Diseases; Horses

The use of cephotaxim in the treatment of obstetric and gynecological patients with various infectious complications, as well as in the treatment of newborn infants in the Department of Intensive Therapy showed it to be highly effective in 100 per cent of the cases. The adverse reactions of cephotaxim were observed in 1 out of 43 patients. It should be noted that cephotaxim did not inhibit the host anaerobic indigenous flora. No cases of dysbacteriosis were recorded. Comparative analysis of the data on determination of the MIC of cephotaxim and cephuroxim with respect to various species of opportunistic microorganisms demonstrated that cephuroxim was more active against Staph. aureus, while cephotaxim against Klebsiella. Cephotaxim displayed activity against part of the strains of Ps. aeruginosa and streptococci of group D, which was not common to cephalosporins of the previous generations.

Topics: Bacterial Infections; Cefotaxime; Cefuroxime; Cephalosporins; Endometritis; Enterococcus faecalis; Escherichia coli; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Kinetics; Klebsiella; Pregnancy; Pseudomonas aeruginosa; Puerperal Infection; Pyelonephritis; Staphylococcus aureus

The therapeutic efficiency of a new cephalosporin derivative, cefotaxime, which is stable against beta-lactamase hydrolysis, has been studied in cases involving perinatal infection. The following results have been obtained. 1. In the treatment of 7 cases of infection, the preparation showed excellent efficacy in 1 case and good efficacy in 5 cases except 1 unknown case. 2. This drug has demonstrated its efficacy in the treatment of 5 cases of infections refractory to ABPC, out of which 1 had excellent and 3 had good results. 3. No side effects were observed in any of our patients. In conclusion, this drug shows excellent efficacy and high safety in the treatment of cases involving infection.

Topics: Adult; Cefotaxime; Drug Evaluation; Endometritis; Female; Humans; Infusions, Parenteral; Pregnancy; Puerperal Infection

Topics: Abscess; Adolescent; Adult; Cefotaxime; Cephalosporins; Endometritis; Female; Humans; Middle Aged; Pelvic Inflammatory Disease; Sepsis