Susceptibility of upper-genital tract isolates from women with pelvic inflammatory disease to ampicillin, cefpodoxime, metronidazole, and doxycycline

Article Abstract:

Although inpatient treatment of pelvic inflammatory disease (PID), a significant cause of infertility, relies on antibiotics that attack a wide variety of infectious organisms, outpatients are usually treated with agents mainly effective against Neisseria gonorrhoeae (causing gonorrhea) and Chlamydia trachomatis (causing the disease referred to as chlamydia). This is true in spite of the fact that current treatment guidelines for pelvic inflammatory disease recommend using drugs against several other organisms. To evaluate the effectiveness of doxycycline, the drug most commonly prescribed for outpatients with PID, and other agents with effectiveness against a greater range of organisms, a study was carried out of 137 microbial isolates from 84 women with confirmed PID. Samples of material from the endometrium (uterine lining) or fluid obtained at laparoscopy were grown in tissue culture and tested for their susceptibility to doxycycline, metronidazole, ampicillin, and cefpodoxime. Results showed that facultative organisms (those that can live with or without oxygen) were resistant to all or some of the agents used: 16 percent were resistant to ampicillin; 9 percent were resistant to defpodoxime, 93 percent were resistant to metronidazole, and 72 percent were resistant to doxycycline. For anaerobic bacteria (which require substances other than oxygen), resistance to the different drugs was: none were resistant to ampicillin; 11 percent were resistant to defpodoxime; 10 percent were resistant to metronidazole; and 56 percent were resistant to doxycycline. The results indicate that doxycycline is mainly effective against Chlamydia strains and that more than one dose of another antibiotic may be needed to combat organisms from the upper female genital tract. This is particularly true of organisms that are not sexually transmitted. A discussion is presented of different drug combinations. Additional research needs to be carried out to evaluate the microbiologic status of the upper genital tract before and after drug treatment for PID. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Doxycycline, Ampicillin

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Etiology of acute pelvic inflammatory disease proven by laparoscopy

Article Abstract:

Chlamydia trachomatis was the most common cause of acute pelvic inflammatory disease (PID) in 40 women studied in an Israeli hospital. Women were examined with a laparoscope to visually confirm the diagnosis of PID. Women who had visual confirmation of their diagnosis were asked to participate in the study. Using the laparoscope, specimens were obtained directly from the affected areas, the Fallopian tubes and any abscesses. The specimens were cultured for C. trachomatis, Neisseria gonorrhoeae, Haemophilus influenzae and a variety of bacteria. C. trachomatis was present in 35% of the patients. In contrast to the United States where N. gonorrhoeae is often the cause of PID, no cases of N. gonorrhoeae infection were found in the Israeli women.

Israel, Demographic aspects, Chlamydia trachomatis, Laparoscopy

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Successful treatment of four patients with recalcitrant vaginal trichomoniasis with a combination of zinc sulfate douche and metronidazole therapy

Article Abstract:

Patients with trichomoniasis unsuccessfully treated with standard therapies may respond to a three-pronged treatment approach. Four previously treated patients with recurring trichomoniasis infections douched twice daily with a solution containing zinc sulfate and then inserted vaginal suppositories medicated with low levels of metronidazole. These patients also took metronidazole tablets three times daily. There was no evidence of infection in any of the patients two to five months after treatment.

Infection, Vagina, Trichomoniasis, Zinc sulfate, Douching

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