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1.  Double-Blind, Multicenter, Prospective Randomized Study of Trospectomycin Vs. Clindamycin, Both With Aztreonam, in Non-Community Acquired Obstetric and Gynecologic Infections 
Objective: The purpose of this study was to compare the clinical efficacy and safety of trospectomycin sulfate with that of clindamycin phosphate, both with aztreonam, for the treatment of obstetric and gynecologic infections.
Methods: In a double-blind, multicenter, prospective randomized study, 579 patients with either endometritis following cesarean delivery or pelvic cellulitis following hysterectomy were enrolled and received medication. Administered was either trospectomycin sulfate 500 mg IV every 8 h or clindamycin phosphate 900 mg IV every 8 h in a 1:1 randomization ratio. Both groups of patients received aztreonam 1 g IV every 8 h. The patients were followed for clinical responses and side effects.
Results: The cure rate for the trospectomycin sulfate arm was 91.8% and for clindamycin phosphate arm it was 88.4% (P = 0.218). The adverse events were similar in both groups.
Conclusions: Trospectomycin was as effective as clindamycin, when both were combined with aztreonam, in treatment of obstetric and gynecologic infections.
doi:10.1155/S1064744997000483
PMCID: PMC2364549  PMID: 18476152
2.  Trospectomycin in Acute Pelvic Inflammatory Disease: A Preliminary Report 
Objective: The purpose of this study was to compare the clinical efficacy and safety of intravenous trospectomycin to that of cefoxitin plus doxycycline in the treatment of women hospitalized with acute pelvic inflammatory disease (PID).
Methods: Thirty-nine patients admitted with a clinical diagnosis of an acute PID were enrolled in this prospective, single-blind study. Patients were treated with either intravenous trospectomycin, 500 mg every 8 h, or intravenous cefoxitin, 2 g every 6 h, plus oral or intravenous doxycycline, 100 mg every 12 h, in a 2:1 ratio. The patients were followed for clinical response and side effects. Both groups of patients were discharged on oral doxycycline for 10 days. Appropriate cultures were obtained before starting inpatient treatment, on completion of inpatient treatment, and at 2 follow-up visits.
Results: The overall success rate for trospectomycin was 95.6% and for cefoxitin/doxycycline was 91.6%. This difference was not statistically significant (P = 0.63). Trospectomycin was found to be effective against Chlamydia trachomatis.
Conclusions: Single-agent therapy with trospectomycin may be as effective as cefoxitin plus doxycycline in the treatment of women hospitalized with acute PID.
doi:10.1155/S1064744997000355
PMCID: PMC2364539  PMID: 18476139
3.  Significance of Genital Mycoplasmas in Pelvic Inflammatory Disease: Innocent Bystander! 
Objective: Our objective was to determine the role of Mycoplasma hominis and Ureaplasma urealyticum in pelvic inflammatory disease (PID).
Methods: The clinical and microbiologic variables in 114 patients with a clinical diagnosis of PID were compared prospectively according to the isolation of M. hominis and U. urealyticum from their endometrial cavities.
Results: The groups were epidemiologically well matched. Clinical parameters such as temperature, leukocyte count, erythrocyte count, and C-reactive protein on admission and length of hospital stay were similar in the patients, regardless of their mycoplasma status. A significant percentage of the patients either continued or started to harbor genital mycoplasmas after the resolution of PID without any significant clinical sequelae.
Conclusions: The presence of genital mycoplasmas does not change the clinical presentation and course of PID. Both M. hominis and U. urealyticum can persist or colonize the endometrium after complete recovery from PID. Therefore, the genital mycoplasmas do not seem to have a dominant pathogenic role in PID.
doi:10.1155/S1064744996000518
PMCID: PMC2364503  PMID: 18476105
4.  Endometrial Cultures in Acute Pelvic Inflammatory Disease 
Objective: The objective of this study was to investigate the correlation of endometrial culture results with the clinical diagnosis of acute pelvic inflammatory disease (PID).
Methods: A total of 130 patients admitted with the clinical diagnosis of acute PID were prospectively enrolled in this study. Endometrial cultures by transcervical aspirate currette were obtained from all patients.
Results: Of 130 patients, 114 were discharged with a clinical diagnosis of PID. Of these 114 patients, 112 had positive endometrial cultures for pathogenic organisms. The correlation between endometrial culture results and the clinical diagnosis of acute PID was 98.2%. When patients with only mycoplasmas in the endometrial cavity were excluded, the correlation between endometrial culture results and the clinical diagnosis of acute PID was 93.8%.
Conclusion: These data demonstrate the exceedingly high degree of correlation between endometrial culture results and the clinical diagnosis of acute PID. Therefore, endometrial cultures may serve as a useful adjunct in the evaluation of patients with a clinical diagnosis of acute PID.
doi:10.1155/S1064744995000317
PMCID: PMC2364417  PMID: 18476020
5.  Chronic Endometritis and Positive Mycoplasma Cultures: Is There a Correlation? 
Objective: This study was undertaken to assess the impact of mycoplasma strains (Mycoplasma hominis or Ureaplasma urealyticum) on the development of chronic endometritis.
Methods: Fifty-eight patients with acute pelvic infection were enrolled in this prospective cohort study. Endometrial cultures and biopsies were obtained on admission and 5–7 and 21–28 days after completion of treatment.
Results: Of 148 samples, 40 were positive for mycoplasma strains (group A) and 58 were positive for mycoplasma with other pathogens (group B). Twenty-seven samples were positive for other pathogens only (group C). Chronic endometritis was seen in 7 (17.5%), 30 (51.7%), and 10 (37%) in group A, B, and C patients, respectively.
Conclusions: The presence of mycoplasma strains in the endometrial cavity was not found to be associated with an increased incidence of chronic endometritis.
doi:10.1155/S1064744995000226
PMCID: PMC2364415  PMID: 18475413
6.  Single-Blind, Prospective, Randomized Study of Cefmetazole and Cefoxitin in the Treatment of Postcesarean Endometritis 
Objective: The purpose of this study was to compare the clinical efficacy and safety of cefmetazole given by IV push with that of parenterally administered cefoxitin for the treatment of endometritis following cesarean delivery.
Methods: In a single-blind, multicenter, prospective, randomized study, 355 patients with endometritis after cesarean delivery were enrolled and received medication. Administered was either cefmetazole sodium, 2 g by IV push over 1 min q 8 h, or cefoxitin sodium, 2 g IV q 6 h in a 2:1 ratio. The patients were followed for clinical responses and side effects.
Results: The cure rate for cefmetazole was 89% and for cefoxitin it was 79% (P = 0.006). The adverse events were similar in both groups.
Conclusions: Cefmetazole was significantly more effective than cefoxitin in the treatment of endometritis following cesarean delivery.
doi:10.1155/S1064744995000263
PMCID: PMC2364413  PMID: 18475417
7.  Perihepatic Adhesions: Another Look 
Objective: The objective of our study was to determine if pelvic inflammatory disease (PID) was the only cause of perihepatic adhesions.
Methods: One hundred consecutive patients undergoing elective sterilization by laparoscopy were enrolled in this study. The preoperative workup included a history, physical examination, cervical culture for Neisseria gonorrhoeae and Chlamydia trachomatis, leukocyte count, C-reactive protein, and liver-function tests. During the laparoscopic procedure, the pelvis and liver surface were inspected for evidence of any adhesions. If perihepatic adhesions were discovered in a patient without any evidence of prior PID, then cultures from the adhesion, peritoneal fluid, and tubal specimens were obtained for N. gonorrhoeae, C. trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, anaerobes, and facultative aerobes. Tubal specimens were also obtained for histologic examination.
Results: Of 100 patients, 7 patients had perihepatic adhesions without any laparoscopic evidence of prior PID. The preoperative cultures were negative. Three of these patients had no history of sexually transmitted disease or PID. Their anti-chlamydial antibody titers were also negative. Of the remaining 4 patients with perihepatic adhesions, 2 had a history of gonococcal or chlamydial infection and 2 had histological evidence of chronic salpingitis.
Conclusions: The study suggests that PID may not be the only cause of perihepatic adhesions.
doi:10.1155/S1064744995000159
PMCID: PMC2364405  PMID: 18475406
8.  Management of Intrauterine Device-Associated Actinomycosis 
Objective: To assess various methods of management of actinomyces-like organisms associated with intrauterine devices.
Methods: A retrospective chart review of 173 patients with intrauterine device-associated actinomyces- like organisms detected on Pap smear was performed. The patients were managed by IUD removal with or without antibiotic therapy, antibiotic therapy alone, or no treatment at all.
Results: The success rate as reflected in negative follow-up smear was 100% for IUD removal combined with antibiotics, 97.4% for IUD removal alone, and 36.8% for antibiotics therapy alone.
Conclusions: The best way to manage intrauterine device-associated actinomyces-like organisms is removal of the device with or without antibiotics.
doi:10.1155/S1064744993000298
PMCID: PMC2364307  PMID: 18475332

Results 1-8 (8)