Selection of antimicrobial agents for treatment of infections of the female genital tract.

Evaluation of the treatment of 501 patients with pelvic infections and a review of the literature indicate that prospects for clinical cure without surgical intervention are markedly better in women seen early in the course of infection than in those with well-established infections. Among hospitalized patients with early infections, treatment regimens of less than 10 days duration were successful. Traditional therapies (initial treatment with ampicillin, a first-generation cephalosporin, or a combination of penicillin and aminoglycoside, penicillin and tetracycline, or a cephalosporin and an aminoglycoside, followed by clindamycin or chloramphenicol if the patient remained febrile) were compared with new antibiotic regimens (initial treatment with second- or third-generation cephalosporins). Among patients with an infected abortion, the results of treatment with traditional regimens were excellent. In patients with salpingo-oophoritis, the immediate cure rates with second- and third-generation cephalosporins were better than those with traditional regimens, but the long-term impact of these drugs on fallopian tube patency is not known. In women with postpartum endomyometritis following cesarean section, double-drug therapy with clindamycin and either gentamicin or ampicillin and single-drug therapy with a second- and third-generation cephalosporin were more effective than traditional therapy.