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Cefoxitin: its role in treatment and prophylaxis of obstetric and gynecologic infections
1Program in Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, Washington 98104.
Insights
Cefoxitin is an effective parenteral antibiotic for obstetric and gynecologic infections. However, its superiority over other antibiotics for pelvic infections, even those involving Bacteroides fragilis, remains unproven due to study limitations.
Area of Science:
- Pharmacology and Infectious Diseases
- Obstetrics and Gynecology
Background:
- Cefoxitin is a widely used parenteral antibiotic in the United States.
- Its broad spectrum, including activity against Bacteroides fragilis, suggests utility in intraabdominal and pelvic infections.
Purpose of the Study:
- To review the efficacy of cefoxitin in obstetric and gynecologic infections.
- To compare cefoxitin with other older and newer antibiotic agents.
Main Methods:
- Review of existing studies on cefoxitin use in obstetric and gynecologic infections.
- Comparative analysis of cefoxitin efficacy against other antibiotics.
Main Results:
- Cefoxitin demonstrates clear effectiveness in treating obstetric and gynecologic infections.
- Many studies had low initial infection rates or small sample sizes, hindering definitive proof of cefoxitin's superiority.
- Antibiotics lacking activity against Bacteroides fragilis have shown comparable effectiveness in pelvic infections.
Conclusions:
- The necessity of Bacteroides fragilis activity for pelvic infection treatment is not definitively proven by current evidence.
- Cefoxitin may be particularly valuable when used adjunctively with surgical drainage for pelvic abscesses.
Abstract:
Cefoxitin has become one of the most used parenteral antibiotics in the United States, perhaps because of a broad spectrum of activity, including activity against Bacteroides fragilis, which makes the drug suitable for prevention and treatment of intraabdominal and pelvic infections. This review focuses on the use of cefoxitin in obstetric and gynecologic infections, with comparisons to older and newer antibiotics. Numerous studies have shown that cefoxitin is clearly effective; in most of these studies, however, either the initial infection rates were low or the sample sizes were small--circumstances making it difficult to establish the superiority of any one agent. Thus, the necessity of using a drug with activity against B. fragilis for prevention and treatment of pelvic infections has not been proven. Several antibiotics without such activity have been equally effective. Cefoxitin may be of particular value when combined with surgical drainage of pelvic abscesses, infections in which control of B. fragilis may be especially important to outcome.