title: Combination antimicrobial therapy in the treatment of acute pelvic inflammatory disease.
abstract: We compared the clinical and microbiologic efficacy of two broad-spectrum combination antimicrobial regimens in the treatment of 148 patients with acute pelvic inflammatory disease. Patients were randomized to inpatient treatment with either cefoxitin and doxycycline (n = 75) or clindamycin and tobramycin (n = 73). These antibiotics were administered intravenously for at least 4 days, and up to 48 hours beyond defervescence. Patients were discharged on a regimen of oral doxycycline or clindamycin in accordance with the intravenous regimen to complete a total duration of therapy of 2 weeks. Neisseria gonorrhoeae (53%) and Chlamydia trachomatis (31%) were the microorganisms that were isolated most frequently from the genital tract of enrolled patients. At follow-up, N. gonorrhoeae was isolated in two patients, and C. trachomatis was isolated in none. The overall initial favorable response rate to combination antimicrobial therapy was 98.5% (130/132) in patients with uncomplicated pelvic inflammatory disease and 81% (13/16) in patients with pelvic inflammatory disease that was complicated by tuboovarian abscess. A greater than 70% decrease in abdominal tenderness score occurred in 89% of 111 patients within 6 weeks of hospital discharge. There were no significant differences between antibiotic treatment groups in any response categories or in toxicity. During the initial hospitalization, five patients (three with tuboovarian abscess; one with a pyosalpinx, and one with intractable acute and chronic pelvic inflammatory disease) required surgical intervention. These results support the recommendation to use broad-spectrum combination antimicrobial therapy for the treatment of acute pelvic inflammatory disease.
authors.affiliation: Departments of Obstetrics, University of California, San Francisco.
authors.forename: D V
authors.initials: DV
authors.lastname: Landers
authors.forename: P
authors.initials: P
authors.lastname: Wolner-Hanssen
authors.forename: J
authors.initials: J
authors.lastname: Paavonen
authors.forename: E
authors.initials: E
authors.lastname: Thorpe
authors.forename: N
authors.initials: N
authors.lastname: Kiviat
authors.forename: M
authors.initials: M
authors.lastname: Ohm-Smith
authors.forename: J R
authors.initials: JR
authors.lastname: Green
authors.forename: J
authors.initials: J
authors.lastname: Schachter
authors.forename: K K
authors.initials: KK
authors.lastname: Holmes
authors.forename: D A
authors.initials: DA
authors.lastname: Eschenbach
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D009174:Mycoplasma / Q000302:isolation & purification; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D011897:Random Allocation
chemical_list: D000900:Anti-Bacterial Agents