title: A randomized comparison of gentamicin-clindamycin and cefoxitin-doxycycline in the treatment of acute pelvic inflammatory disease.
abstract: In this prospective trial, 130 hospitalized patients with acute pelvic inflammatory disease based on clinical criteria were randomly treated with intravenous gentamicin plus clindamycin (N = 63) or cefoxitin plus doxycycline (N = 67) for at least 4 days, followed by oral clindamycin or doxycycline, respectively, for a total of 14 days. Pre-treatment cultures were obtained for endocervical Neisseria gonorrhoeae and Chlamydia trachomatis, and for endometrial C trachomatis and aerobic and anaerobic bacteria. Overall, 46 subjects (35%) had endocervical cultures positive for N gonorrhoeae. Endocervical and endometrial cultures were positive for C trachomatis in 16 and 6%, respectively. Ninety-five percent of patients had at least one aerobic bacterium, 38% had at least one anaerobic bacterium, and only 2% had no organisms isolated from their endometrium. Fifty-seven subjects taking gentamicin-clindamycin (90.5%) and 64 subjects taking cefoxitin-doxycycline (95.5%) were clinically cured, a nonsignificant difference. Three subjects treated with gentamicin-clindamycin and one treated with cefoxitin-doxycycline required hysterectomy or salpingectomy for cure. Follow-up examinations and cultures were performed in 84% of the subjects. Post-treatment cultures for N gonorrhoeae were negative in all cases tested. Post-treatment endocervical and endometrial C trachomatis cultures were negative in ten of 11 subjects treated with gentamicin-clindamycin and in eight of nine treated with cefoxitin-doxycycline, a nonsignificant difference. We conclude that gentamicin-clindamycin and cefoxitin-doxycycline have similar clinical cure rates for acute pelvic inflammatory disease and are equivalent in eradicating genital N gonorrhoeae and C trachomatis.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio.
authors.forename: M D
authors.initials: MD
authors.lastname: Walters
authors.forename: R S
authors.initials: RS
authors.lastname: Gibbs
mesh_terms: D000208:Acute Disease; D000328:Adult; D001419:Bacteria / Q000302:isolation & purification; D002440:Cefoxitin / Q000008:administration & dosage* / Q000627:therapeutic use; D002584:Cervix Uteri / Q000382:microbiology; D002981:Clindamycin / Q000008:administration & dosage* / Q000627:therapeutic use; D004318:Doxycycline / Q000008:administration & dosage* / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004717:Endometrium / Q000382:microbiology; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy* / Q000382:microbiology; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
chemical_list: D005839:Gentamicins; D002981:Clindamycin; D002440:Cefoxitin; D004318:Doxycycline