One hundred nineteen patients with tuboovarian abscess were evaluated for response to antibiotics. Results were stratified into three groups by antimicrobial regimen. Group 1 consisted of 37 patients treated with a single-agent broad-spectrum intravenous antibiotic and oral doxycycline. Initial clinical response (defined as decreased pain, diminished white blood cell count, or defervescence) in group 1 was 31/37 (84%). Group 2 consisted of 64 patients treated with clindamycin in combination with an aminoglycoside with or without a penicillin. There was an initial clinical response in 45 of 64 (70%). Group 3 consisted of 18 patients from group 1 who were changed to a clindamycin-containing regimen after 2 to 3 days of initial treatment with a single-agent broad-spectrum antibiotic. The decision to switch antibiotics was not based on treatment failure but occurred when delayed ultrasonography confirmed the diagnosis of tuboovarian abscess. The switch reflected physician preference for clindamycin-containing regimens in the treatment of tuboovarian abscesses. The response rate in this subset of patients was 14 of 18 (78%). Overall initial clinical response rate was 90 of 119 (75%). There were no statistically significant demographic or clinical differences among the three groups. There was no statistical difference in the rate of early and late antibiotic failure rates among the groups. Our study demonstrates that extended-spectrum antibiotic coverage, including single-agent broad-spectrum antibiotics such as cefoxitin, in conjunction with doxycycline has efficacy that is equivalent to that of clindamycin-containing regimens. An overall medical treatment success rate of 75% suggests that conservative treatment of tuboovarlan abscesses is warranted.
Bibliographical noteFunding Information:
From the Department of Obstetrzcs, Gynecology and Reproductive Sciences, Unwerslty ofCalifornia, San FranCIsco, and San FrancIsco General HospItal. Supported in part b_~ NatIOnal InstItutes of Health grant 1P01 AI 24768. Presented by invItation at the Fifty-seventh Annual Meeting of the Pacific Coast Obstetncal and Gynecologzcal SOClet.~, Sun Valley, Idaho, September 9-14. 1990 Repnnt requests: RIchard L. Sweet, MD, Department of Obstetrics and Gynecology, Room 6D14, San FranCIsco General HospItal, 1001 Potrero Ave., San FrancISco, CA 9-1110. 6/6/27945
- Tuboovarian abscess
- antimicrobial therapy
- pelvic abscess
- pelvic inflammatory disease
- tuboovarian complex