Ticarcillin/clavulanate in the treatment of pelvic infections

Ticarcillin/clavulanate was used to treat 130 women with pelvic infections. The 129 who completed an initial course of treatment with ticarcillin/clavulanate were analyzed according to type and clinical severity of infection, and pretreatment and posttreatment endometrial bacteriology. There were 26 cases of pelvic inflammatory disease and 103 puerperal infections, 61 of which occurred in women who had delivered by cesarean section (46 elective with no antibiotic prophylaxis at the time of surgery). Of the 129 patients treated, 124 were clinically cured, and one improved (97%). There were four treatment failures, all of which were among a total of 20 cases classified as clinically severe. All the patients designated as treatment failures required prolonged treatment with other antibacterials to achieve a clinical cure, but a longer duration of treatment with ticarcillin/clavulanate might have effected a clinical resolution even in these cases. In vitro examination of endometrial isolates revealed a significant reduction of the minimum inhibitory concentrations (MICs) of beta-lactamase-producing bacteria with the addition of clavulanate to ticarcillin. The relationship of non-beta-lactamase-producing enterococci having relatively high MICs to clinical failure was examined.