cefoxitin and Chlamydia-Infections

A statistical analysis of 58 reports involving 101 clinical trials and over 4,000 patients revealed that there was no statistically significant difference in the cure rates between single-agent and combination therapy. Also, there was no difference in the cure rates between antibiotic regimens that cover Chlamydia trachomatis and those that do not. However, there was a difference in cure rates when regimens with good antianaerobe activity were compared to those with poor coverage of anaerobes. There was a statistically significantly higher cure rate when "newer" regimens (mainly the second and third generations of cephalosporins and newer penicillins) were compared to "older" regimens (mainly penicillin and tetracycline). In 91 comparisons there were no statistically significant differences between regimens with a > 90% cure rate. Optimum therapy is discussed in terms of the cure rate, coverage of known pathogens and antibiotic toxicity. The original and revised recommendations of the Centers for Disease Control for the treatment of acute pelvic inflammatory disease are also reviewed.

Topics: Acute Disease; Anti-Bacterial Agents; Aztreonam; Cefotetan; Cefoxitin; Chlamydia Infections; Chlamydia trachomatis; Clindamycin; Drug Evaluation; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Gentamicins; Humans; Pelvic Inflammatory Disease; Tetracycline Resistance

We investigated the association between endometritis and reproductive morbidity.. Participants were 614 women in the PID Evaluation and Clinical Health (PEACH) Study with pelvic pain, pelvic organ tenderness, and leukorrhea, mucopurulent cervicitis, or untreated cervicitis. We compared women with endometritis (>or=5 neutrophils or >or=2 plasma cells), Neisseria gonorrhoeae or Chlamydia trachomatis upper genital tract infection (UGTI) or both to women without endometritis/UGTI for outcomes of pregnancy, infertility, recurrent pelvic inflammatory disease (PID), and chronic pelvic pain (CPP), adjusting for age, race, education, PID history, and baseline infertility.. Endometritis/UGTI was not associated with reduced pregnancy (odds ratio [OR] 0.8, 95% CI 0.6-1.2) or elevated infertility (OR 1.0, 95% CI 0.6-1.6), recurrent PID (OR 0.6, 95% CI 0.4-0.9), or CPP (OR 0.6, 95% CI 0.4-0.9). PEACH participants with and without endometritis/UGTI had higher age- and race-specific pregnancy rates than 1997 national rates.. Among women with clinically suspected mild-to-moderate PID treated with standard antibiotics, endometritis/UGTI was not associated with reproductive morbidity.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Cefoxitin; Chlamydia Infections; Doxycycline; Endometritis; Endometrium; Female; Gonorrhea; Humans; Infertility, Female; Odds Ratio; Pelvic Inflammatory Disease; Pregnancy; Probenecid; Time Factors

A multicenter randomized comparative trial was done to assess the safety and efficacy of oral ofloxacin (400 mg twice daily for 10 days) versus cefoxitin (2 g intramuscularly) followed by doxycycline (100 mg twice daily orally for 10 days) for the outpatient treatment of uncomplicated pelvic inflammatory disease (PID). Neisseria gonorrhoeae (GC) grew on pretreatment endocervical cultures from 43 of 268 women (16%), and in 30 of 247 women (12%) cultures were positive for Chlamydia trachomatis (Ct). Ninety-five percent (122/128) of the women treated with the ofloxacin regimen and 93% (112/121) of those treated with the cefoxitin/doxycycline regimen had cure or improvement on examination at a minimum of one follow-up visit. All GC species were eradicated by both ofloxacin and cefoxitin. Among women who returned for follow-up, the eradication of C trachomatis was 88% (15/17) for the cefoxitin/doxycycline group and 100% (18/18) for ofloxacin. Side effects were more prevalent in the cefoxitin/doxycycline group (15%) than in the ofloxacin group (7%), nausea/vomiting being the most frequent adverse effect. In this study, it appears that ofloxacin and cefoxitin/doxycycline have similar clinical effectiveness for the outpatient treatment of uncomplicated pelvic inflammatory disease.

Topics: Adolescent; Adult; Ambulatory Care; Cefoxitin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Drug Therapy, Combination; Female; Gonorrhea; Humans; Middle Aged; Ofloxacin; Pelvic Inflammatory Disease; Probenecid; Treatment Outcome

The object of this randomized study was to compare the safety and efficacy of oral ofloxacin, 400 mg twice daily for 10 days, versus intramuscular cefoxitin, 2 gm, plus oral probenecid, 1 gm, followed by oral doxycycline, 100 mg twice daily for 10 days, in the outpatient treatment of uncomplicated acute salpingitis. Thirty-eight women (53%) had Neisseria gonorrhoeae from their pretreatment endocervical or endometrial cultures, and 18 had Chlamydia trachomatis (25%). Thirty-five of 37 women (95%) treated with the ofloxacin regimen were clinically cured, and 34 of 35 (97%) were cured with the cefoxitin-doxycycline regimen (p = 0.52). One clinical failure occurred in each group with N. gonorrhoeae infection, and one failure occurred in the ofloxacin group because of side effects. The bacteriologic response for N. gonorrhoeae in both groups was 100%. The eradication of C. trachomatis was 100% (10/10) for the cefoxitin/doxycycline group and 86% (6/7) for ofloxacin. The side effects were similar in both groups of subjects. In this study both regimens were effective for the outpatient treatment of uncomplicated acute salpingitis.

Topics: Acute Disease; Adult; Ambulatory Care; Cefoxitin; Chi-Square Distribution; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Drug Therapy, Combination; Female; Gonorrhea; Humans; Ofloxacin; Probenecid; Salpingitis

Acute pelvic inflammatory disease remains the major medical and economic consequence of sexually transmitted diseases among young women. The polymicrobial origins of pelvic inflammatory disease have been well documented and the major organisms recovered from the upper genital tract in patients with pelvic inflammatory disease include Chlamydia trachomatis, Neisseria gonorrhoeae, and mixed anaerobic and aerobic bacteria. This study was undertaken to compare the efficacy and safety of cefotetan plus doxycycline with that of cefoxitin plus doxycycline in the treatment of hospitalized patients with acute pelvic inflammatory disease. A total of 68 hospitalized patients with acute pelvic inflammatory disease were entered and randomized into two treatment groups: cefotetan (n = 32) and cefoxitin (n = 36). There were six tuboovarian abscesses in each group. C. trachomatis was recovered from 7 (10%) and N. gonorrhoeae from 48 (71%) of the patients. Anaerobic and aerobic bacteria were recovered from the upper genital tract in 53 (78%) of the patients. Cefotetan plus doxycycline and cefoxitin plus doxycycline demonstrated high rates of initial clinical response in the treatment of acute pelvic inflammatory disease. Clinical cure was noted in 30 (94%) of the cefotetan plus doxycycline group and 33 (92%) of the cefoxitin plus doxycycline group. Four failures were sonographically diagnosed tuboovarian abscesses that responded to clindamycin plus gentamicin therapy. The fifth failure was an uncomplicated case that did not respond to cefoxitin and doxycycline and required additional therapy. At 1 week and 3 weeks, respectively, the posttreatment cultures demonstrated eradication, in all instances, of N. gonorrhoeae and C. trachomatis. These regimens also were very effective in eradicating anaerobic and aerobic pathogens from the endometrial cavity. Both regimens were well tolerated by the patients, and few adverse drug affects were noted.

Topics: Acute Disease; Adolescent; Adult; Cefotetan; Cefoxitin; Cephamycins; Chlamydia Infections; Doxycycline; Drug Therapy, Combination; Female; Gonorrhea; Hospitalization; Humans; Pelvic Inflammatory Disease

C-reactive protein (CRP), a biological marker of inflammation, may be a useful indicator of therapeutic response in patients with septic pelvis. In a study comparing ceftizoxime and cefoxitin/doxycycline in patients with septic pelvis, quantitative CRP levels were closely correlated with the responses and failures of therapy. The results of this study showed the two antibiotic regimens to be equally effective, with 23 of 25 patients in each treatment group achieving a satisfactory response. The fact that ceftizoxime was effective in four of five patients with Chlamydia trachomatis in cervical isolates suggests that intravenous therapy for the acute infection can be accomplished without the addition of an antichlamydial agent. Upon discharge from the hospital, patients can continue therapy with an oral drug that is specifically active against Chlamydia.

Topics: C-Reactive Protein; Cefotaxime; Cefoxitin; Ceftizoxime; Chlamydia Infections; Doxycycline; Drug Combinations; Female; Gonorrhea; Humans; Injections, Intravenous; Random Allocation; Salpingitis

Sulbactam/ampicillin and cefoxitin were compared in the treatment of 20 patients with acute salpingitis diagnosed during laparoscopy. Results were evaluated during laparoscopic follow-up at 2 months. Sulbactam/ampicillin appeared to be a better treatment, producing better results in tubal patency, adhesions and persistent inflammation than cefoxitin. In addition, the combination of sulbactam/ampicillin with doxycycline appears to provide better results than the combination of cefoxitin with doxycycline in chlamydial salpingitis. It is concluded that sulbactam/ampicillin is an effective treatment for nonchlamydial salpingitis.

Topics: Acute Disease; Adult; Ampicillin; Cefoxitin; Chlamydia Infections; Doxycycline; Drug Therapy, Combination; Female; Fertility; Humans; Penicillanic Acid; Prognosis; Salpingitis; Sulbactam; Tissue Adhesions

Sixty-three women with abdominal pain and adnexal tenderness were enrolled in a study of ambulatory treatment of acute pelvic inflammatory disease. Treatment consisted of 2 g of cefoxitin intramuscularly and 1 g of probenecid orally, followed by doxycycline, 100 mg by mouth twice daily for 14 days. Patients were stratified into groups indicating whether pelvic inflammatory disease was probable, possible, or unlikely, based upon endometrial biopsy and clinical criteria. Among 52 women who were evaluated, Chlamydia trachomatis and/or Neisseria gonorrhoeae were initially recovered from 16 (67%) of 24 with probable pelvic inflammatory disease, three (33%) of 11 with possible pelvic inflammatory disease, and three (18%) of 17 in whom pelvic inflammatory disease was considered unlikely. Of the 24 patients with probable pelvic inflammatory disease, 22 (92%) were clinically cured or improved. Of 22 patients initially infected with C trachomatis and/or N gonorrhoeae, 20 were culture-negative for both organisms after therapy. Both microbiologic failures had been reexposed. This study suggests that the combination of cefoxitin and doxycycline is effective for ambulatory treatment of pelvic inflammatory disease.

Topics: Adult; Ambulatory Care; Biopsy; Cefoxitin; Chlamydia Infections; Doxycycline; Endometritis; Female; Follow-Up Studies; Gastrointestinal Diseases; Gonorrhea; Humans; Pelvic Inflammatory Disease; Salpingitis

This article reviews the rationale for the therapy of acute salpingitis and the conceptual basis for the length of therapy. The key to therapy of acute salpingitis is the need to accommodate polymicrobial etiology, polymicrobial bacterial superinfection, and the potential presence of penicillinase-producing strains of Neisseria gonorrhoeae into a therapeutic equation that has been determined by the appropriate staging of disease. The anticipated therapeutic response identified for monomicrobial disease due to Neisseria gonorrhoeae constitutes the end titration point for drug administration. Duration of continued therapy beyond this point is governed by the need to complete therapy for Chlamydia trachomatis or to assure resolution of advanced disease.

Topics: Acute Disease; Anti-Bacterial Agents; Cefoxitin; Chlamydia Infections; Chlamydia trachomatis; Doxycycline; Drug Therapy, Combination; Female; Gonorrhea; Humans; Metronidazole; Neisseria gonorrhoeae; Penicillinase; Salpingitis; Time Factors

The Gainesville staging of acute salpingitis subdivides the complexity of clinical disease into four major stages. Each stage is predicated upon distinct therapeutic goals and different therapeutic regimens for achieving the principal goal of each stage.. The classical signs of salpingitis are fever, bilateral adnexal tenderness and/or the presence of masses, and signs of an elevated white blood count (WBC) and erythrocite sedimentation rate. These are absent in the majority of women. Acute salpingitis should be suspected in any woman with lower abdominal discomfort and can be verified by needle culdocentesis. Proper staging can be a deciding factor in the patient's cure and future fertility and helps in the selection of antibiotics. The presence or absence of Neisseria gonorrhoeae should be determined first. Some complicating factors during these procedures include: 1) the presence of an IUD when disease within the fallopian tubes tends to be more advanced than can be ascertained from clinical findings, 2) prior inflammatory disease of the fallopian tube, and 3) bilateral tubal ligation. If peritonitis has been inferred by the demonstration of rebound tenderness or by culdocentesis, confirmation can be achieved by ultrasonography or CAT scan of the pelvis. Once the variables have been identified the information can be assessed according to the current classification of acute salpingitis; staging is an attempt to create clinical subjects based upon the fact that each differs in its major therapeutic goal. For acute salpingitis without peritonitis, therapy is with doxycycline. For acute salpingitis with peritonitis, in order to preserve fallopian structure and function, there has to be adequate coverage for principal venereal pathogens, and treatment is a combination of cefoxitin and doxycycline. For acute salpingitis with evidence of tubal occlusion or ruptured tuboovarian complex treatment is with penicillin, clindamycin, and tobramycin. For a case of ruptured tuboovarian complex combinations of antibiotics are used and if these fail surgery is indicated.

Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Infections; Cefoxitin; Chlamydia Infections; Doxycycline; Female; Humans; Peritonitis; Salpingitis