Combination antimicrobial therapy in the treatment of acute pelvic inflammatory disease

Daniel V. Landers, Pal Wolner-Hanssen, Jorma Paavonen, Edwin Thorpe, Nancy Kiviat, Marilyn Ohm-Smith, James R. Green, Julius Schachter, King K. Holmes, David A. Eschenbach, Richard L. Sweet

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40 Scopus citations


We compared the clinical and microbiologic efficacy of two broad-spectrum combination antimicrobial regimens in the treatment of 148 patients with acute pelvic inflammatory disease. Patients were randomized to inpatient treatment with either cefoxitin and doxycycline (n = 75) or clindamycin and tobramycin (n = 73). These antibiotics were administered intravenously for at least 4 days, and up to 48 hours beyond defervescence. Patients were discharged on a regimen of oral doxycycline or clindamycin in accordance with the intravenous regimen to complete a total duration of therapy of 2 weeks. Neisseria gonorrhoeae (53%) and Chlamydia trachomatis (31%) were the microorganisms that were isolated most frequently from the genital tract of enrolled patients. At follow-up, N. gonorrhoeae was isolated in two patients, and C. trachomatis was isolated in none. The overall initial favorable response rate to combination antimicrobial therapy was 98.5% (130/132) in patients with uncomplicated pelvic inflammatory disease and 81% (13/16) in patients with pelvic inflammatory disease that was complicated by tuboovarian abscess. A > 70% decrease in abdominal tenderness score occurred in 89% of 111 patients within 6 weeks of hospital discharge. There were no significant differences between antibiotic treatment groups in any response categories or in toxicity. During the initial hospitalization, five patients (three with tuboovarian abscess, one with a pyosalpinx, and one with intractable acute and chronic pelvic inflammatory disease) required surgical intervention. These results support the recommendation to use broad-spectrum combination antimicrobial therapy for the treatment of acute pelvic inflammatory disease.

Original languageEnglish (US)
Pages (from-to)849-858
Number of pages10
JournalAmerican journal of obstetrics and gynecology
Issue number3
StatePublished - 1991

Bibliographical note

Funding Information:
From the Departments of Obstetrics, Gynecology and Reproductive Sciences and Laboratory Medicine, University of California, San Francisco, San Francisco General Hospital: and the Departments of Obstetrics and Gynecology, Pathology, and Medicine, University of Washington, Harborview Medical Center.' Supported in part by National Institutes of Health grants AI12192 and 1P01 Al24768 and by Merck, Sharp & Dohme, Westpoint, Pennsylvania. Received for publication April 25, 1990; accepted October 25, 1990. Reprint requests: Daniel V. Landers, MD, San Francisco General Hospital, Room 6D14, 1001 Potrero Ave., San Francisco, CA 94110. 6/1/26354


  • Pelvic inflammatory disease
  • acute salpingitis
  • pelvic infections
  • sexually transmitted diseases


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