A prospective, randomized clinical trial was conducted to compare the efficacy and tolerance of a single dose of 1 g
ceftriaxone i.v. daily with 3 doses of 1 g
cefotaxime i.v. daily for obstetric and gynecologic
infections. Both agents are characterized by a wide spectrum and potent activity. Furthermore,
ceftriaxone has an outstanding serum half-life of 8 h. 41 patients with
pelvic inflammatory disease, pelvic or
wound infections after vaginal or abdominal
hysterectomy,
endomyometritis and
urinary-tract infection were included. Patients were monitored clinically by routine laboratory methods (erythrocyte sedimentation rate, white blood cell count and cross-reacting
protein) and bacteriologically. Clinical parameters of
infection were
fever, local
pain and/or tenderness, a sactosalpinx or pyosalpinx at palpation and cervical secretion. Clinical cure was achieved in 77.3% in the
ceftriaxone and in 78.9% in the
cefotaxime group, improvement in 3 (13.6%) and 4 patients (21.0%), respectively. 2 clinical failures were seen in the
ceftriaxone group. One was a severe
pelvic infection following
vaginal hysterectomy, which responded to the addition of
metronidazole, the other was due to a chlamydial
salpingitis, which was cured with a 10-day course of
doxycycline. Both
antibiotics were well tolerated. Our results suggest that for obstetric and gynecologic
infections a single 1-gram dose of
ceftriaxone is equally effective as three 1-gram doses of
cefotaxime.