Efficacy of sulbactam plus ampicillin in gynecologic infections

The efficacy of sulbactam plus ampicillin in the treatment of various gynecologic infections was evaluated in 24 women (median age, 35 years). Ten women had pelvic cellulitis plus vaginal cuff abscess; six, pyeloperitonitis; three, vaginal cuff abscess; three, surgical wound sepsis; one, tubo-ovarian abscess; and one, endometritis. Surgical procedures preceding infection included abdominal hysterectomy, ovarian cyst removal, ectopic pregnancy, correction of cystocele, and uterine dilatation and curettage. Twenty patients received 1 g of sulbactam plus 1 g of ampicillin per dose; four received 0.5 g of sulbactam plus 1 g of ampicillin per dose. The combination was given iv every 6 hr for three to four days and then im every 8 hr for three to five days (mean treatment duration, seven days). Pus cultures yielded Enterobacteriaceae (21 cases), enterococci (two), Bacteroides fragilis (12), other Bacteroides species (five), Peptococcus species (nine), Peptostreptococcus species (seven), and other anaerobes (five). Six infections were purely anaerobic; 18 were mixed. All but two infections were cured by both clinical and bacteriologic criteria, with no adverse reactions. Parenteral sulbactam/ampicillin seems safe and effective in the treatment of gynecologic infections of moderate severity.