Piperacillin sodium (
Pipracil, Lederle Laboratories, Wayne, New Jersey), a new semisynthetic
penicillin, demonstrated in vitro activity against a broad spectrum of clinical pathogens. It is active against most strains of the clinically important gram-negative aerobic or facultative bacteria and against virtually all the clinically important anaerobic organisms, including Bacteroides fragilis and Bacteroides bivius. This broad antibacterial spectrum suggested that
piperacillin might be an effective single
antimicrobial agent for the treatment of mixed aerobic/anaerobic
infections in obstetric and gynecologic patients. In this study, the clinical efficacy and safety of
piperacillin was compared with that of
cefoxitin in the management of
pelvic infections. There were 23 patients in the
piperacillin group (acute
salpingitis, 12;
endomyometritis, 7;
pelvic cellulitis, 2; tuboovarian
abscess, 2) and 25 patients in the
cefoxitin group (acute
salpingitis, 13;
endomyometritis, 10; tuboovarian
abscess, 2). An average of six bacteria were isolated from each patient. Aerobic bacteria only were recovered from 12.5%, anaerobic bacteria only in 6.5%, and both aerobic and anaerobic bacteria were present in 82.5% of patients. Overall, 21 of 23 (91%) of the
piperacillin treatment group and 23 of 25 (92%) of the
cefoxitin group responded to
therapy with
antimicrobial agents alone. The major cause of failure was the presence of an
abscess.
Piperacillin was shown to be an effective single agent for the management of
pelvic infections caused by mixed aerobic and anaerobic bacteria. In addition,
piperacillin proved to be safe and well tolerated.