Summary
The clinical efficacy and safety of sulbactam/ampicillin versus metronidazole/gentamicin were compared in 39 patients with severe pelvic infections. 30 patients had severe acute pelvic inflammatory disease with peritonitis, 3 tubo-ovarian abscesses, 4 endomyometritis, and 2 posthysterectomy pelvic cellulitis. Aerobic and anaerobic cultures from the sites of infection yielded 259 micro-organisms from 38 patients; an average of 6.8 bacteria per infection (3.9 anaerobes and 2.9 aerobes). The most frequent isolates were Bacteroides spp. (21), B. bivius (13), B. disiens (8), Fusobacterium spp. (9), Peptostreptococcus anaerobius (15), P. asaccharolyticus (8), anaerobic Gram-positive cocci (17), Gardnerella vaginalis (24), Neisseria gonorrhoeae (14), α-haemolytic streptococci (6) and Escherichia coli (3).
Clinical cure was noted in 19 of 20 patients treated with sulbactam/ampicillin and 16 of 19 treated with metronidazole/gentamicin. The sulbactam/ampicillin failure was a patient with pelvic inflammatory disease with a positive Chlamydia trachomatis culture who required antichlamydial therapy. The metronidazole/gentamicin failures included a patient with a tubo-ovarian abscess requiring surgical drainage and 2 patients with pelvic inflammatory disease requiring antichlamydial treatment. No adverse haematological, renal, or hepatic effects were noted with either regimen.
References
English AR, Retsema JA, Girard AE, Lynch JE, Barth WE. CP-45,899, a beta-lactamase inhibitor that extends the antibacterial spectrum of beta-lactams: Initial bacteriological characterization. Antimicrobial Agents and Chemotherapy 14: 414–419, 1978
Eschenbach DA, Buchanan TM, Pollack HM, et al. Polymicrobial etiology of acute pelvic inflammatory disease. New England Journal of Medicine 293: 166–171, 1975
Ledger WJ. Selection of antimicrobial agents for treatment of infections of the female genital tract. Reviews of Infectious Diseases 5 (Suppl): 98–104, 1983
Sweet RL. Treatment of mixed aerobic-anaerobic infections of the female genital tract. Journal of Antimicrobial Chemotherapy 8(Suppl. D): 105–114, 1981
Sweet RL, Draper DL, Schacter J. Microbiology and pathogenesis of acute salpingitis as determined by laparoscopy: What is the appropriate site to sample? American Journal of Obstetrics and Gynecology 138: 985–989, 1980
Sweet RL, Schacter J, Robbie MO. Failure of beta-lactam antibiotics to eradicate Chlamydia trachomatis in the endometrium despite apparent clinical cure of acute salpingitis. Journal of the American Medical Association 250: 2641–2645, 1983
Wise R, Andrews JM, Bedford KA. Clavulanic acid and CP-45,899: A comparison of their in vitro activity in combination with penicillins. Journal of Antimicrobial Chemotherapy 6: 197–206, 1980
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Crombleholme, W., Landers, D., Ohm-Smith, M. et al. Sulbactam/Ampicillin versus Metronidazole/Gentamicin in the Treatment of Severe Pelvic Infections. Drugs 31 (Suppl 2), 11–13 (1986). https://doi.org/10.2165/00003495-198600312-00003
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-198600312-00003