Recent advances in antibiotic regimens for the treatment of obstetric-gynecologic infections.

This paper reviews new information on antimicrobial agents for the treatment of obstetric-gynecologic infections. The bacteriology of these infections is complex, reflecting the bacteria that usually colonize the vagina and cervix. In general, these infections are polymicrobial in nature: the most frequently isolated microorganisms are gram-negative facultative aerobes, anaerobes, Chlamydia trachomatis, and Neisseria gonorrhoeae. Antibiotic regimens that do provide coverage of these pathogens showed unacceptably high failure rates. A review of the studies recently published confirmed the recommendations of the US Centers for Disease Control and Prevention for severe (inpatients) and mild-to-moderate (outpatients) pelvic inflammatory disease infections. In the case of severe infections, two regimens are recommended: a second-generation cephalosporin like cefoxitin or cefotetan, plus doxycycline or clindamycin/gentamicin. In the case of mild-to-moderate infection, a second- or third-generation cephalosporin plus doxycycline, or oral clindamycin plus an oral quinolone are recommended. Such studies produce high bacteriologic and clinical success rates. New studies indicate that gentamicin may be replaced with a monobactam such as aztreonam; this regimen leads to slightly better efficacy and less toxicity. The possibility of using clindamycin and a quinolone antibiotic is also discussed.