cefoxitin and Endometritis

A review of the literature indicates that cefoxitin is an effective single-agent therapy for community-acquired intra-abdominal infections, pelvic infections, and surgical prophylaxis. Hospital-acquired intra-abdominal infections may require the addition of an aminoglycoside.

Topics: Biliary Tract Diseases; Cefoxitin; Cesarean Section; Colonic Diseases; Endometritis; Female; Humans; Hysterectomy; Infection Control; Male; Postoperative Complications; Pregnancy; Puerperal Infection; Rectal Diseases

As pelvic inflammatory disease (PID) aetiology is not completely understood, we examined the relationship between select novel bacteria, PID and long-term sequelae.. Fastidious bacterial vaginosis (BV)-associated bacteria (Sneathia (Leptotrichia) sanguinegens, Sneathia amnionii, Atopobium vaginae and BV-associated bacteria 1 (BVAB1)), as well as Ureaplasma urealyticum and Ureaplasma parvum were identified in cervical and endometrial specimens using organism-specific PCR assays among 545 women enrolled in the PID Evaluation and Clinical Health study. Risk ratios and 95% CIs were constructed to determine associations between bacteria, histologically confirmed endometritis, recurrent PID and infertility, adjusting for age, race, gonorrhoea and chlamydia. Infertility models were additionally adjusted for baseline infertility.. Persistent detection of BV-associated bacteria was common (range 58% for A. vaginae to 82% for BVAB1) and elevated the risk for persistent endometritis (RRadj 8.5, 95% CI 1.6 to 44.6) 30 days post-cefoxitin/doxycycline treatment, independent of gonorrhoea and chlamydia. In models adjusted for gonorrhoea and chlamydia, endometrial BV-associated bacteria were associated with recurrent PID (RRadj 4.7, 95% CI 1.7 to 12.8), and women who tested positive in the cervix and/or endometrium were more likely to develop infertility (RRadj 3.4, 95% CI 1.1 to 10.4). Associations between ureaplasmas and PID sequelae were modest.. To our knowledge, this is the first prospective study to demonstrate that S. sanguinegens, S. amnionii, BVAB1 and A. vaginae are associated with PID, failure of the Centers for Disease Control and Prevention-recommended treatment to eliminate short-term endometritis, recurrent PID and infertility. Optimal antibiotic regimens for PID may require coverage of novel BV-associated microbes.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cefoxitin; Doxycycline; Drug Therapy, Combination; Endometritis; Female; Humans; Infertility, Female; Pelvic Inflammatory Disease; Prospective Studies; United States; Vagina; Vaginosis, Bacterial; Young Adult

There are only few studies concerning the usage of antibiotics in preventing endometritis after uterine curettage for spontaneous first trimester incomplete abortion and no conclusion can be demonstrated. To investigate the effectiveness of prophylactic cefoxitin in preventing endometritis after uterine curettage for spontaneous first trimester incomplete abortion.. Eighty-four women with spontaneous first trimester incomplete abortion were randomly allocated into two groups using a computer-generated random number list and the allocation concealment was maintained using a sealed opaque envelope. The patients in the study group were given 1 g of cefoxitin while the patients in the control group were given 0.1 ml of vitamin B complex intravenously 20 minutes prior to curettage. Uterine curettage was performed after intravenous sedation and analgesic drugs were administered. The patients were evaluated on the first, third and seventh day after uterine curettage.. Seventy-nine cases had completed the study protocol. There were no statistically significant differences in demographic data and details of uterine curettage between both groups. Two cases of endometritis were found in the control group but none in the study group. However the difference did not reach the statistical significance (p = 0.241).. Prophylactic cefoxitin is not effective in preventing endometritis after uterine curettage for spontaneous first trimester incomplete abortion.

Topics: Abortion, Incomplete; Abortion, Spontaneous; Adult; Anti-Bacterial Agents; Cefoxitin; Dilatation and Curettage; Endometritis; Female; Humans; Pregnancy; Statistics, Nonparametric; Treatment Outcome

The purpose of this study was to determine the effect of intrapartum prophylactic antibiotics in the prevention of postpartum sepsis in laboring women who were infected with HIV.. In a double-blind, randomized trial that was conducted in Durban (South Africa), pregnant women who were infected with HIV in whom vaginal delivery was anticipated were randomized to receive either a single dose of cefoxitin (2 g) or placebo intrapartum. Signs of sepsis were evaluated within 72 hours and at 1 and 2 weeks postpartum.. Of the 424 women who were enrolled, 213 women received cefoxitin, and 211 women received placebo. Both groups were comparable in all baseline parameters. The overall sepsis rate was 19% (40/211 women) in the placebo group and 16.9% (36/213 women) in the cefoxitin group (P = .581). There was a 53% reduction in risk of postpartum endometritis in the cefoxitin group (95% confidence interval, 0.24-0.9).. The use of prophylactic intrapartum cefoxitin in HIV-infected women reduces the risk of postpartum endometritis.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefoxitin; Double-Blind Method; Drug Administration Schedule; Endometritis; Female; HIV Infections; Humans; Incidence; Pregnancy; Pregnancy Complications, Infectious; Puerperal Disorders; South Africa

As Mycoplasma genitalium is associated with pelvic inflammatory disease (PID), we examined the efficacy of a commonly used PID antimicrobial in treating M genitalium upper genital tract infection.. In the PID Evaluation and Clinical Health study of inpatient versus outpatient treatment, 682 women treated with cefoxitin and doxycycline for clinically suspected PID had stored cervical and endometrial specimens available for analysis. In the current sub study, we compared baseline endometritis, short term treatment failure (continued endometritis and pelvic pain 30 days following treatment) and sequelae among women with and without M genitalium, identified using PCR.. Endometrial M genitalium was associated with baseline endometritis (adjusted OR 3.0, 95% CI 1.5 to 6.1). Among women with a positive baseline M genitalium test, 41% tested positive again 30 days following treatment. Women testing positive compared to those testing negative for M genitalium at baseline had an increased risk of short-term treatment failure (RR 4.6, 95% CI 1.1 to 20.1). Rates of sequelae, including infertility (22%), recurrent PID (31%) and chronic pelvic pain (42%), were high among women testing positive for endometrial M genitalium at baseline. There was a non-significant trend towards increased infertility, chronic pelvic pain and recurrent PID, and decreased pregnancy and live birth following M genitalium infection.. M genitalium is associated with endometritis and short-term PID treatment failure. Cefoxitin and doxycycline, a Centers for Disease Control and Prevention recommended PID treatment regimen, is ineffective for the treatment of M genitalium upper genital tract infection.

Topics: Adult; Aged; Anti-Bacterial Agents; Cefoxitin; Doxycycline; Drug Therapy, Combination; Endometritis; Female; Humans; Infertility, Female; Middle Aged; Mycoplasma genitalium; Mycoplasma Infections; Pelvic Inflammatory Disease; Recurrence; Risk Factors; Treatment Failure

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

To evaluate the efficacy and safety of ampicillin-sulbactam (3 g every 6 hours) in patients with pelvic inflammatory disease or postpartum endometritis using a randomized, comparative, multicenter study of parallel design.. Eligible patients with pelvic inflammatory disease were randomized to receive either ampicillin-sulbactam or cefoxitin (2 g every 6 hours) plus doxycycline (100 mg every 12 hours). Those with endometritis were randomized to ampicillin-sulbactam or clindamycin (900 mg every 8 hours) plus gentamicin (1.5 mg/kg every 8 hours). In the ampicillin-sulbactam group, chlamydia-positive patients also received oral doxycycline.. For pelvic inflammatory disease, the clinical response rates (cure or improvement) were 85.5% (47 of 55) and 89.6% (43 of 48) in the ampicillin-sulbactam and cefoxitin and doxycycline groups, respectively (chi 2 = 0.10, P = .76). For endometritis, the clinical response rates were 88.7% (141 of 159) and 90.8% (139 of 153) in the ampicillin-sulbactam and clindamycin and gentamicin groups, respectively (chi 2 = 0.15, P = .70). The percentages of patients with pelvic inflammatory disease who had adverse experiences were not significantly different in the cefoxitin and doxycycline group (47% [29 of 62]) than in those receiving ampicillin-sulbactam (33% [22 of 66]) (P = .12). These adverse effects were mostly mild or moderate. In the endometritis subjects, the incidence of adverse experiences in the ampicillin-sulbactam group (11% [20 of 179]) was comparable to that during treatment with clindamycin and gentamicin (12% [22 of 180]). These adverse experiences were also mostly mild to moderate.. Ampicillin-sulbactam is as effective and well tolerated as combination regimens using cefoxitin plus doxycycline and clindamycin plus-gentamicin for the treatment of pelvic inflammatory disease or endometritis, respectively.

Topics: Adult; Ampicillin; Cefoxitin; Clindamycin; Doxycycline; Drug Therapy, Combination; Endometritis; Female; Gentamicins; Humans; Pelvic Inflammatory Disease; Puerperal Infection; Sulbactam

The authors used a two-stage design to compare the risk of endometritis in women undergoing non-elective cesarean section who received cefazolin prophylaxis (n = 481) with those who received cefoxitin prophylaxis (n = 1799). The primary data source for this study was an automated record linkage system which allowed the ascertainment of exposure(antibiotic prophylaxis) and preliminary ascertainment of outcome (post-partum endometritis) on a consecutive sample of women undergoing cesarean section between 1 April 1987 and 30 September 1989. Potentially important covariates not available in the automated data source were sampled by review of complete medical records of a random sample of each exposure-disease category of the cohort. Of the 2280 women studied, 99 (4.3%) developed postpartum endometritis. After control for age, race, anemia, presence of ruptured membranes, parity, labor, number of vaginal examinations and payor status the adjusted odds ratio for cefazolin compared to cefoxitin was 0.95 (95% C.I. 0.5-1.9). The cost of prophylaxis was significantly higher for women who received cefoxitin prophylaxis ($56/patient vs $9.55/patient). These results suggest that cefazolin prophylaxis should be favored over cefoxitin due to lower cost and similar efficacy. This study also demonstrates the efficiency of a two-stage design in the setting where exposure and outcome are available for an entire cohort but information about important covariates is more difficult to obtain.

Topics: Adult; Cefazolin; Cefoxitin; Cesarean Section; Endometritis; Female; Humans; Postoperative Complications; Pregnancy; Premedication; Puerperal Infection; Research Design

The hypothesis of the study is that cefotetan and cefoxitin will be equally efficacious and safe in the treatment of post-cesarean section endometritis.. In a double-blind, randomized manner 140 patients with post-cesarean section endometritis were treated with cefotetan, 2 gm intravenously every 12 hours, or cefoxitin, 2 gm intravenously every 6 hours. They were followed prospectively for clinical response and side effects. Cure rates between the two groups were compared with the chi 2 test.. The cure rates were 83% for cefotetan and 79% for cefoxitin (p = 0.56). No patient required a change in therapy due to adverse effects, and no abnormal bleeding occurred.. In this study cefotetan and cefoxitin appeared equally effective in treating endometritis with no difference in side effects or complications.

Topics: Adult; Bacteria; Cefotetan; Cefoxitin; Cesarean Section; Double-Blind Method; Endometritis; Female; Humans; Pregnancy; Prospective Studies; Recurrence

A prospective, randomized, double-blind trial was done to compare the efficacy of cefoxitin (2 grams given intravenously every six hours) with ceftizoxime (2 grams given intravenously every 12 hours) in the treatment of postpartum endometritis. Thirty-eight patients received cefoxitin and 43 received ceftizoxime. Demographic variables (age, gravidity, parity and estimated gestational age) and risk factors (cesarean section, operating time, duration of ruptured membranes and labor, number of vaginal examinations and internal monitoring) were not statistically different in the two antibiotic groups. In the cefoxitin group, eight of 38 patients failed initial antibiotic therapy and six of 43 patients in the ceftizoxime group failed (p = 0.399). In the univariate analysis, abdominal wound infection (p = 0.003) and higher gestational age (p = 0.008) were associated with failure of the antibiotic. With multiple logistic regression, only abdominal wound infection was associated with failure of the antibiotic (p = 0.0002). We conclude that cefoxitin and ceftizoxime are equally effective in the therapy of postpartum endometritis and that abdominal wound infection is primarily responsible for persistent fever and, therefore, failure of the antibiotic in patients with postpartum endometritis.

Topics: Adult; Cefoxitin; Ceftizoxime; Cesarean Section; Cost-Benefit Analysis; Double-Blind Method; Endometritis; Female; Humans; Length of Stay; Multivariate Analysis; Prospective Studies; Puerperal Infection; Risk Factors; Surgical Wound Infection; Treatment Outcome

One hundred thirty-six patients were enrolled in a randomized, double-blind, placebo-controlled trial of oral antibiotic therapy (amoxicillin) versus placebo following successful intravenous (IV) antibiotic therapy for postpartum endometritis. No subjects were readmitted to the hospital for recurrent endometritis and there were no wound infections or recurrent fevers. Minor side effects were seen in 10% of those taking amoxicillin and 14% of those taking placebo. Compliance was fair; only 52% of those taking amoxicillin and 65% of those taking placebo completed therapy. The lack of infectious complications in this high-risk population suggests that oral antibiotic therapy is unnecessary after successful IV antibiotic therapy for endometritis.

Topics: Administration, Oral; Adult; Amoxicillin; Ampicillin; Cefoxitin; Clindamycin; Double-Blind Method; Drug Therapy, Combination; Endometritis; Female; Gentamicins; Humans; Injections, Intravenous; Puerperal Infection; Recurrence; Sulbactam

The introduction of antibiotic prophylaxis for cesarean delivery has decreased the risk of postpartum endometritis and wound infection, but factors that contribute to prophylaxis failure are not understood. To determine factors that might contribute to postpartum infections following antibiotic prophylaxis, we cultured amniotic fluid, decidua, and chorioamniotic membrane specimens for anaerobic and facultative bacteria and for genital mycoplasmas at cesarean delivery. Women were assessed daily for the development of infections, and if endometritis developed, a protected endometrial culture was obtained. Postpartum endometritis developed in 16 and wound infection in four of 102 women. Infection rates were similar for women receiving cefotetan (N = 50) or cefoxitin (N = 52) for prophylaxis. The isolation of group B streptococcus (P less than .001) or Enterococcus faecalis (P = .03) from the upper genital tract at delivery was significantly associated with postpartum endometritis. Antibiotic-resistant organisms (other than enterococci) were recovered uncommonly at delivery or with postpartum infections. Group B streptococcus was susceptible to the prophylactic agents used, suggesting that virulence factors other than antibiotic resistance are important for the development of postpartum endometritis. Group B streptococcus, E faecalis, and bacteria associated with bacterial vaginosis were recovered from the endometrium at the time of postpartum endometritis.

Topics: Bacterial Infections; Cefotetan; Cefoxitin; Cesarean Section; Double-Blind Method; Endometritis; Endometrium; Extraembryonic Membranes; Female; Humans; Placenta; Postoperative Complications; Pregnancy; Premedication; Surgical Wound Infection

To describe the microbiologic etiology of post-cesarean endometritis developing after perioperative cephalosporin prophylaxis, endometrial samples were obtained from 27 women with a triple-lumen catheter. The women were assigned in a double-blind, randomized fashion to receive either ticarcillin/clavulanate, 3.1 g, or cefoxitin, 2 g, administered every six hours, until the clinical signs of infection resolved. A total of 149 microorganisms (84 facultative and 65 obligate anaerobes) were recovered from 26 women, for a mean of 5.5 isolates per specimen. One endometrial specimen was sterile. Bacteroides and Peptostreptococcus species were the most frequent isolates, followed by Gardnerella vaginalis, Enterococcus, facultative gram-negative rods and Mycoplasma hominis. Each of the isolates was tested for beta-lactamase activity. At least one beta-lactamase-producing isolate was recovered from 56% of the specimens. Susceptibility testing of endometrial isolates demonstrated that 96% of 118 potential pathogens (Gardnerella, Bacteroides, Peptostreptococcus, enterococci and streptococci) were susceptible to ticarcillin/clavulanate. By comparison, 86% of these isolates were susceptible to cefoxitin in vitro. Women who were treated with ticarcillin/clavulanate were less likely to have a temperature greater than 38 degrees C for two or more days (8% vs. 57%, P = .01). Also, there was a trend toward a decreased duration of uterine tenderness in the ticarcillin/clavulanate group, but it did not attain statistical significance (60% vs. 86%, P = .4). However, the overall clinical success rate with these single-agent treatments was not different for the two groups (77% vs. 79%, P = 1.0).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacterial Infections; Bacteroides; Cefoxitin; Cephalosporins; Cesarean Section; Clavulanic Acids; Double-Blind Method; Drug Evaluation; Drug Therapy, Combination; Endometritis; Female; Humans; Penicillins; Peptostreptococcus; Postoperative Complications; Pregnancy; Randomized Controlled Trials as Topic; Ticarcillin

To more clearly understand the microbiology of acute salpingitis in our patients and to evaluate the clinical efficacy and safety of recommended and new therapeutic regimens, 126 women who met clinical diagnostic criteria for acute community-acquired pelvic inflammatory disease underwent endocervical and endometrial cultures prior to random intravenous therapy with cefoxitin plus doxycycline, ceftizoxime plus doxycycline or ceftizoxime alone (two regimens). Nine women (7%) had Chlamydia, and 70 (56%) had gonococci in endometrial specimens (P less than .001). Only two women (3.4%) given monotherapy required altered medical therapy, and none required surgery. Parenteral combination therapy was associated more frequently with adverse clinical and laboratory events.

Topics: Acute Disease; Adolescent; Adult; Bacteria; Bacterial Infections; Cefoxitin; Ceftizoxime; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Endometritis; Female; Humans; Microbial Sensitivity Tests; Prospective Studies; Random Allocation; Salpingitis; Uterine Cervicitis

Two hundred eighty-seven women were treated in a multicenter, randomized, comparative study to compare the safety and efficacy of cefotetan every 12 hours with that of cefoxitin every 6 or 8 hours in the treatment of acute obstetric and gynecologic pelvic infections. The most frequent primary diagnoses in both groups were endometritis and pelvic inflammatory disease; 24 of these patients were also bacteremic. The mean duration of treatment was 5.2 and 5.4 days for the cefotetan and cefoxitin groups, respectively, and the total doses administered were 18.1 and 32.1 gm, respectively. The rate of clinical failure for the cefotetan group was 8.5% and 12.2% for the cefoxitin group. Laboratory and clinical adverse reactions were infrequent and none was serious; both antimicrobials were well tolerated. These results suggest the administration of cefotetan provided adequate clinical and bacteriologic effectiveness in the treatment of hospital- and community-acquired, polymicrobial obstetric and gynecologic pelvic infections.

Topics: Acute Disease; Adult; Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Clinical Trials as Topic; Cross Infection; Endometritis; Female; Genital Diseases, Female; Humans; Pelvic Inflammatory Disease; Random Allocation

Because of the high incidence of beta-lactamase production among bacteria that are found commonly in pelvic infections in women, beta-lactamase-inhibiting antibiotics should prove effective in treating those infections. In a randomized, comparative study of 47 women with intraabdominal infections, 23 received ticarcillin disodium/clavulanate potassium, and 24 received cefoxitin. Among the infections treated were endometritis, pelvic inflammatory disease, amnionitis, salpingitis, septicemia, intraabdominal abscess and pelvic abscess. The bacteriologic response to ticarcillin disodium/clavulanate potassium was 88.8% success as compared with 87.5% for cefoxitin. Clinical cures were achieved in 98.8% of patients treated with ticarcillin disodium/clavulanate potassium and 90.9% of patients treated with cefoxitin. The adverse reactions were diarrhea, transient eosinophilia and transient thrombocytosis.

Topics: Adult; Bacterial Infections; beta-Lactamase Inhibitors; Cefoxitin; Clavulanic Acid; Clavulanic Acids; Clinical Trials as Topic; Drug Combinations; Endometritis; Female; Humans; Pelvic Inflammatory Disease; Penicillins; Random Allocation; Ticarcillin

Cefotetan is a recently introduced cephamycin antibiotic for parenteral administration, with a broad spectrum of antibacterial activity. Its elimination half-life of three hours or more allows a twice-daily dosage schedule. A noncomparative trial of cefotetan yielded a satisfactory clinical response in the treatment of all of ten patients with pelvic infection. Subsequently, we did a prospective, randomized comparative study of 53 patients with pelvic infections treated with either cefotetan (2 gm IV every 12 hours) or cefoxitin (2 gm IV every six to eight hours). Both drugs showed similar clinical efficacy and antimicrobial activity (100% [n = 36] with cefotetan and 94% [n = 17] with cefoxitin, the difference not statistically significant). A mean of 21.3 gm of cefotetan was required, as compared with 34.4 gm of cefoxitin, a statistically significant difference (P less than .001). Use of cefotetan is therefore more cost effective.

Topics: Adult; Bacteria; Bacterial Infections; Cefotetan; Cefoxitin; Cephamycins; Chorioamnionitis; Endometritis; Female; Genital Diseases, Female; Humans; Microbial Sensitivity Tests; Pelvic Inflammatory Disease; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Random Allocation

A randomized, prospective study compared a long-acting, second-generation cephalosporin, cefonicid (Monocid), with a short-acting, second-generation cephalosporin, cefoxitin (Mefoxin), for cesarean section prophylaxis. One hundred thirty-nine patients were enrolled, with 81 receiving a 1-g intravenous dose of cefonicid after cord clamping and 58 receiving a 2-g dose of intravenous cefoxitin after cord clamping and at 6, 12 and 18 hours postpartum. In those patients receiving cefonicid prophylaxis, endometritis incidence was 17.3% (14 of 81). This finding was not statistically significant (P less than .397) when compared to the 12.1% incidence of endometritis (7 of 58) with cefoxitin. In addition, the febrile morbidity incidence for cefonicid prophylaxis was 23.5% (19 of 81) as compared to 15.5% (9 of 58) for cefoxitin (P less than .25). Because the two drugs appear to be equally efficacious, cefonicid may be the better choice because of its markedly lower cost.

Topics: Adult; Age Factors; Cefamandole; Cefonicid; Cefoxitin; Cesarean Section; Endometritis; Female; Humans; Pregnancy; Prospective Studies; Random Allocation; Risk Factors; Socioeconomic Factors

The efficacy of mezlocillin versus cefoxitin versus clindamycin plus gentamicin was evaluated in 152 patients with postpartum endometritis. There were no statistically significant differences in rate of cure among the three groups (87% with mezlocillin, 82% with cefoxitin, and 92% with clindamycin-gentamicin). There were no severe adverse reactions observed in any of the three treatment regimens. Mezlocillin is as safe and effective as cefoxitin and clindamycin-gentamicin for treatment of postpartum endometritis.

Topics: Bacteriuria; Cefoxitin; Clindamycin; Drug Evaluation; Endometritis; Endometrium; Female; Humans; Injections, Intravenous; Mezlocillin; Pregnancy; Prospective Studies; Puerperal Infection; Random Allocation

Preliminary results of a randomised trial comparing parenteral sulbactam 1g plus ampicillin 2g every 8 hours and cefoxitin 2g every 8 hours in 75 patients with gynaecological infection are reported. Clinical and bacteriological cure were achieved in 87% and 91% of patients treated with sulbactam/ampicillin compared with 83% and 59% treated with cefoxitin. Both treatments were well tolerated.

Topics: Adolescent; Adult; Ampicillin; Bacterial Infections; beta-Lactamase Inhibitors; Cefoxitin; Child; Clinical Trials as Topic; Drug Therapy, Combination; Endometritis; Female; Genital Diseases, Female; Humans; Penicillanic Acid; Peritonitis; Random Allocation; Salpingitis; Sulbactam

The route of administration of prophylactic antibiotics was studied in a randomized prospective trial. Cefoxitin was administered to high-risk patients at cesarean section by three treatment regimens: intravenous antibiotic (2 g) for eight doses, irrigation of uterus and peritoneum with 2 g of antibiotic, and a combination of intravenous and irrigation as described. A control group received no antibiotic prophylaxis. The incidence of febrile morbidity was similar in each treatment group: intravenous, two of 39 (5%); irrigation, three of 42 (7%); intravenous and irrigation, two of 38 (5%), and were all significantly lower than the control group 14 of 39 (36%) (P less than .05). Similar results were found when prevention of endometritis was the end point: intravenous, two of 39 (5%); irrigation, two of 42 (5%); intravenous and irrigation, two of 38 (5%) compared with 13 of 39 (33%) in the control group (P less than .05). Administration of antibiotics by irrigation is equally effective in preventing postoperative febrile morbidity and endomyometritis as intravenous dosing and a combination of intravenous and irrigation. This affords a potential cost savings.

Topics: Adult; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Combined Modality Therapy; Endometritis; Female; Humans; Infusions, Parenteral; Pregnancy; Premedication; Prospective Studies; Random Allocation; Risk; Surgical Wound Infection; Therapeutic Irrigation

A protected, triple-lumen transcervical culture method was used to recover organisms from the endometrium. At least one facultative or one anaerobic species of bacteria was recovered from 82% of the patients, and genital mycoplasmas were recovered from 76% of the women with endometritis. Bacteria together with genital mycoplasmas were present in 61% of the women, bacteria alone were present in 20%, genital mycoplasmas alone were present in 16%, and Chlamydia trachomatis was isolated from 2% of the patients. The most common organisms included Gardnerella vaginalis, Peptococcus spp., Bacteroides spp., Staphylococcus epidermidis, group B Streptococcus, and Ureaplasma urealyticum. A randomized, double-blind regimen of either piperacillin or cefoxitin was equally successful in treating the postpartum endometritis.

Topics: Bacteriuria; Cefoxitin; Chlamydia trachomatis; Endometritis; Female; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Mycoplasma; Piperacillin; Pregnancy; Puerperal Infection

A prospective, double-blind study was performed to evaluate the comparative efficacy of single- and multiple-dose antimicrobial prophylaxis for preventing infection in high-risk patients undergoing cesarean section. One hundred fifty-eight patients were randomly assigned to receive either a single perioperative dose of mezlocillin, three doses of mezlocillin or three doses of cefoxitin. The incidence of endometritis was 5.9%, 4.0% and 4.0%, respectively. The incidence of febrile morbidity was 5.9%, 2.0% and 6.1%, respectively. These differences are not statistically significant. The single perioperative dose of mezlocillin was as effective as the three-dose regimen of either mezlocillin or cefoxitin.

Topics: Adult; Bacterial Infections; Cefoxitin; Cesarean Section; Double-Blind Method; Endometritis; Female; Humans; Mezlocillin; Postoperative Complications; Pregnancy; Premedication; Prospective Studies; Random Allocation; Urinary Tract Infections

Cefoxitin and clindamycin-gentamicin were compared in a randomized study of antibiotic therapy for infections of the pelvis in 91 women. Clinical diagnoses included pelvic inflammatory disease (53), endomyometritis after cesarean section (24), and cellulitis following gynecological surgery (14). Treatment failures occurred in four (10%) of the 41 patients treated with cefoxitin compared with eight (16%) of the 50 patients treated with the clindamycin-gentamicin combination. Single-drug therapy with cefoxitin was shown to be as effective as the combination of clindamycin and gentamicin.

Topics: Adolescent; Adult; Cefoxitin; Cellulitis; Clindamycin; Drug Therapy, Combination; Endometritis; Female; Gentamicins; Humans; Middle Aged; Pelvic Inflammatory Disease; Random Allocation

Topics: Bacterial Infections; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Endometritis; Female; Humans; Mezlocillin; Pregnancy; Premedication; Prospective Studies; Random Allocation; Surgical Wound Infection; Ureaplasma

Topics: Cefoxitin; Cesarean Section; Chorioamnionitis; Clavulanic Acid; Clavulanic Acids; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Endometritis; Female; Humans; Penicillins; Pregnancy; Premedication; Prospective Studies; Ticarcillin; Urinary Tract Infections

Ninety-three female patients with post-cesarean endometritis, post-hysterectomy pelvic cellulitis, and other miscellaneous moderately severe pelvic soft-tissue infections were treated in a randomized fashion with either ticarcillin plus clavulanic acid or cefoxitin. Of the 47 patients treated with ticarcillin plus clavulanic acid, 38 had clinical cures, four showed improvement, therapy failed in three, and two were nonevaluable, for a failure rate of 6.7 percent. Of the 46 patients treated with cefoxitin, 33 had clinical cures, five showed improvement, therapy failed in seven, and one was nonevaluable, for a failure rate of 15.6 percent. Bacteriologically, the addition of clavulanic acid to ticarcillin was found to broaden the antibacterial spectrum to include some Escherichia coli, most Klebsiella, many coagulase-negative staphylococci, and all isolates of Staphylococcus aureus. Adverse reactions were few, with only one patient having therapy with cefoxitin discontinued because of side effects. It is concluded that ticarcillin plus clavulanic acid is quite suitable for antibiotic therapy of female pelvic soft-tissue infection, based on the (expanded) coverage of both aerobic and anaerobic bacterial species.

Topics: Adolescent; Adult; Bacterial Infections; Cefoxitin; Cellulitis; Clavulanic Acid; Clavulanic Acids; Drug Combinations; Endometritis; Female; Humans; Middle Aged; Pelvic Inflammatory Disease; Penicillins; Ticarcillin

Despite recent enthusiasm for antibiotic prophylaxis by uterine irrigation at the time of cesarean section, no data exists comparing the efficacy of this technique with standard intravenous antibiotic administration. Therefore, 124 patients about to undergo cesarean section were entered into a prospective, randomized, double-blind evaluation of uterine irrigation versus intravenous administration of either normal saline or cefoxitin. All women were considered to be at increased risk for postoperative infection because of the presence of labor or ruptured membranes. The incidence of endometritis and the fever index in patients receiving intravenous cefoxitin (3.2%, 4.6 degree hours) was significantly less than in patients receiving intravenous normal saline (21.2%, 22.3 degree hours). There was no significant difference between the use of intravenous normal saline and uterine irrigation with either cefoxitin (18.9%, 16.6 degree hours) or normal saline (17.4%, 24.6 degree hours). These results suggest that intravenous infusion is the most effective means of administering cefoxitin as a prophylactic antibiotic.

Topics: Adult; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Endometritis; Female; Fetal Membranes, Premature Rupture; Humans; Infusions, Parenteral; Pregnancy; Premedication; Prospective Studies; Random Allocation; Sodium Chloride; Therapeutic Irrigation

The effectiveness of intraoperative irrigation with cefoxitin was compared prospectively with that of a short course of intravenous cefoxitin as prophylaxis against endometritis. One hundred three patients who underwent primary cesarean at University Hospital, Jacksonville, Florida, were randomized into two study groups. The first group received intraoperative cefoxitin irrigation. The second group received a short course of intravenous cefoxitin prophylaxis and intraoperative saline irrigation. The resulting incidence of endometritis was 3.8% and 4%, respectively. There was no statistically significant difference between the use of the cefoxitin solution and the short course of intravenous cefoxitin.

Topics: Cefoxitin; Cesarean Section; Endometritis; Female; Humans; Infusions, Parenteral; Intraoperative Period; Pregnancy; Premedication; Prospective Studies; Random Allocation; Risk; Therapeutic Irrigation

A prospective, blinded, placebo-controlled study was performed to determine the minimum effective duration of short-term antibiotic prophylaxis following cesarean section. Cefoxitin was selected as the study drug, and 189 women at high risk for postoperative infectious morbidity were randomly assigned to three cohorts, each receiving intravenous infusions at cord clamping and at 4 and 8 hours postoperatively. The incidence of endometritis in the placebo group was 29.3% versus 9.4% in patients receiving one dose of cefoxitin (2 gm) at cord clamping and 5.0% in patients receiving three doses of cefoxitin (p less than 0.0001). Cefoxitin prophylaxis significantly reduced the incidence of endometritis in patients with postoperative anemia. There were no serious complications or drug reactions in the treated groups.

Topics: Adult; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Endometritis; Female; Humans; Postoperative Complications; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Random Allocation; Risk

The effectiveness of prophylactic cefoxitin in preventing postcesarean section infection was studied in a high risk population. One hundred women were evaluated, and on a random double-blind basis 50 received placebo and 50 received cefoxitin. There were three doses of drug given intravenously, either placebo or 1 gram of cefoxitin at the time of cord clamping and again four and eight hours later. Those receiving cefoxitin had significantly less postoperative infections, fewer had bacteremia and there was less postoperative fever as measured by the fever index. The patient with the most protracted infection in this study received cefoxitin. Problems with the use of systemic antibiotic prophylaxis in preventing postcesarean section infection are discussed. Cefoxitin is an effective agent to use in patients undergoing cesarean section who are at high risk for infection.

Topics: Adult; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Endometritis; Female; Humans; Mexico; Postoperative Complications; Pregnancy; Premedication; Prospective Studies; Puerperal Infection; Random Allocation

We performed a randomized, double-blind trial on a relatively low-risk population comparing the use of three doses of cefoxitin vs. placebo in the prevention of infection following primary cesarean section. Major site-related morbidity (endometritis, wound infection and septicemia) was significantly reduced in the cefoxitin group (8.9% vs. 27.8%; p = 0.017). Febrile morbidity alone tended to occur in the cefoxitin group (15.6% vs. 3.7%; p = 0.091), and all five urinary tract infections occurred in the cefoxitin group as well. Total morbidity was therefore not significantly different (cefoxitin, 35.6%; placebo, 31.5% [not significant]). Duration of hospitalization (mean, 6.0 days) and need for further postoperative antibiotic therapy were similar in the two groups. Our study demonstrated a modest benefit from the perioperative use of antibiotics in relatively low-risk patients undergoing primary cesarean section. Issues that need further study include definition of the optimal prophylactic regimen and of high-risk populations for whom prophylaxis would be most helpful.

Topics: Adult; Cefoxitin; Cesarean Section; Clinical Trials as Topic; Double-Blind Method; Endometritis; Female; Fever; Humans; Placebos; Postoperative Complications; Pregnancy; Premedication; Sepsis; Surgical Wound Infection; Urinary Tract Infections

To determine the efficacy of perioperative cefoxitin in preventing infections after primary cesarean section, a randomized placebo-controlled, double-blind clinical trial was performed. Among 266 participants, those who received three perioperative 2 gm doses of cefoxitin (138) had significantly fewer serious infections (19.5% vs. 4.3%), fewer urinary tract infections (10.7% vs. 4.4%), less standard febrile morbidity (9.4% vs. 3.6%), and fewer courses of antibiotics postoperatively (23.4% vs. 11.6%). There was no reduction in the length of hospitalization. Use of perioperative cefoxitin umbilical cord is clamped are safe and efficacious in preventing infection after primary cesarean section.

Topics: Cefoxitin; Cesarean Section; Clinical Trials as Topic; Endometritis; Female; Fever; Humans; Infant, Newborn; Intraoperative Care; Postoperative Care; Pregnancy; Prospective Studies; Puerperal Infection; Random Allocation; Sepsis; Urinary Tract Infections

This prospective study was designed to compare the relative efficacy of two antibiotic regimens for the treatment of operative site infections subsequent to pelvic operations. Patients with endomyoparametritis after delivery or pelvic cellulitis subsequent to hysterectomy were randomized to treatment with the combination of penicillin-gentamicin or the single agent cefoxitin. Seventeen of the 26 patients (65%) with endomyoparametritis who were treated with penicillin-gentamicin were cured by antibiotic therapy alone, in comparison to 15 of 23 (65%) patients treated with cefoxitin. Fifty-eight percent of the patients with pelvic cellulitis who were treated with penicillin-gentamicin responded favorably, in comparison to 50% of the patients treated with cefoxitin. None of these differences was statistically significant. In this study, neither antibiotic regimen provided satisfactory initial treatment for surgically induced soft tissue pelvic infection. Moreover, 11 of the 28 patients with treatment failures (40%) developed serious sequelae of their primary infection.

Topics: Bacterial Infections; Cefoxitin; Cesarean Section; Clindamycin; Clinical Trials as Topic; Delivery, Obstetric; Drug Therapy, Combination; Endometritis; Female; Gentamicins; Humans; Hysterectomy; Infant, Newborn; Parametritis; Penicillins; Peptococcus; Postoperative Complications; Pregnancy; Prospective Studies; Puerperal Infection; Staphylococcal Infections; Streptococcus agalactiae

Prophylactic cefoxitin was evaluated in 101 patients undergoing cesarean section. A three-dose regimen of either cefoxitin or placebo was administered randomly in a double-blind manner, 46 patients receiving cefoxitin and 55 placebo, with the first dose given after the cord was clamped. In the placebo group, 29% of the patients developed pelvic or wound infection, compared to 4% in the cefoxitin group (P less than 0.003). No patient required re-operation, re-admission, or had a life threatening infection. Ten risk factors for infection were analyzed to help ascertain which patients would benefit from prophylaxis. Cefoxitin, with a broad spectrum of aerobic and anaerobic coverage, was found to be an effective and safe prophylactic agent when given to all patients undergoing cesarean section.

Topics: Adult; Cefoxitin; Cesarean Section; Double-Blind Method; Endometritis; Female; Humans; Postoperative Complications; Pregnancy; Random Allocation; Surgical Wound Infection

Topics: Cefoxitin; Cephalosporins; Clinical Trials as Topic; Drug Resistance, Microbial; Endometritis; Female; Humans; Pregnancy; Puerperal Infection

In this study, cefoxitin alone (2 gm, every 8 hours) was generally sufficient to cure postpartum endometritis, even when the patient had received prophylaxis with a beta-lactam antibiotic. When single-agent therapy fails, addition of ampicillin usually results in a prompt clinical response.

Topics: Cefoxitin; Endometritis; Enterococcus faecalis; Female; Humans; Infusions, Intravenous; Microbial Sensitivity Tests; Mycoplasma; Pregnancy; Puerperal Infection; Ureaplasma

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

Antibiotic prophylaxis and febrile morbidity following non-elective Caesarean section were studied retrospectively. Febrile morbidity was found to be 5.4% in the treated group as compared to 20% in the untreated group. Percentage of endomyometritis was 2.2% in the treated group and 16% in the untreated group. Our results prove the efficacy of antibiotic prophylaxis in patients undergoing Caesarean section. Antibiotic application in 79% of all these patients led to a significant reduction in puerperal febrile morbidity and endomyometritis. Experience shows that positive results gained by the study do not have a positive feedback on the ward if there is lack of communication or reconfirmation.

Topics: Cefoxitin; Cesarean Section; Endometritis; Female; Humans; Pregnancy; Premedication; Puerperal Infection; Risk; 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

Previous studies have demonstrated a reduction in the incidence of endomyometritis by using irrigation with 1000 ml of saline as a diluent at cesarean section. In this study 2 gm of cefoxitin sodium in 20 ml of saline solution was used for local application to the uterus and abdominal wound in 100 patients undergoing emergency cesarean section; results were compared to those in 100 patients who received no antibiotic at operation. Six patients in the treatment group developed endomyometritis as opposed to 33 in the untreated group (p less than 0.001) and hospital stay was reduced by almost 2 days (p less than 0.001). Local use of cefoxitin sodium appears effective in reducing the incidence of endomyometritis. A prospective double-blind study, however, is imperative before definite conclusions can be made.

Topics: Cefoxitin; Cesarean Section; Endometritis; Female; Humans; Pregnancy; Risk; Time Factors

The in vitro activity of mezlocillin, a new ureidopenicillin, against 377 obligate anaerobes from the female genital tract, was studied by an agar dilution technique. Mezlocillin demonstrated broad-spectrum activity against all genital obligate anaerobes, with a geometric mean minimum inhibitory concentration (MIC) of 4.2 microgram/ml, and inhibited 84% of B. fragilis and 99% of all isolates at 64 microgram of the antibiotic per milliliter. At readily attainable serum concentrations, mezlocillin inhibited significantly more isolates than cefoxitin (p less than 0.0005), ampicillin (p less than 0.0005), penicillin G (p less than 0.005), and clindamycin (p less than 0.025); its activity was comparable to that of carbenicillin and chloramphenicol. Mezlocillin was significantly more active than ampicillin (p less than 0.025), penicillin G (p less than 0.025), and clindamycin (p less than 0.05) against Bacteroides species other than B. fragilis and B. melaninogenicus.

Topics: Ampicillin; Anti-Bacterial Agents; Bacteria; Carbenicillin; Cefoxitin; Chloramphenicol; Clindamycin; Endometritis; Female; Humans; Mezlocillin; Microbial Sensitivity Tests; Penicillin G; Penicillins; Pregnancy; Puerperal Infection