Use of expanded spectrum cephalosporins for the treatment of obstetrical and gynecological infections.

The antianaerobic cephalosporins, cefoxitin, ceftizoxime, cefotetan, and moxalactam, are compared in the treatment of obstetric/gynecologic infections associated with mixed aerobic and anaerobic pathogens. All of the antianaerobic cephalosporins have demonstrated similar efficacy in the treatment of mixed female genital tract infections. Thus, antibiotic selection requires a comparison of the antimicrobial activity, pharmacokinetics, adverse effects, and overall cost of therapy. All agents have excellent activity against the Gram-negative bacilli, and recent comparative data show that ceftizoxime is highly active against the Bacteroides sp. Dosing frequency and drug toxicity contribute to the overall cost of drug therapy. Cefoxitin is the only antianaerobic cephalosporin that cannot be dosed on a 12-hour basis. Ceftizoxime and cefoxitin, unlike moxalactam and cefotetan, do not contain the MTT group that has been associated with bleeding abnormalities. Substantial cost savings can be realized by using an antianaerobic cephalosporin administered every 12 hours. The experience at the Chicago Lying-in Hospital is presented.