A prospective, randomized, double-blind trial was done to compare the efficacy of
cefoxitin (2 grams given intravenously every six hours) with
ceftizoxime (2 grams given intravenously every 12 hours) in the treatment of postpartum
endometritis. Thirty-eight patients received
cefoxitin and 43 received
ceftizoxime. Demographic variables (age, gravidity, parity and estimated gestational age) and risk factors (
cesarean section, operating time, duration of ruptured membranes and labor, number of vaginal examinations and internal monitoring) were not statistically different in the two
antibiotic groups. In the
cefoxitin group, eight of 38 patients failed initial
antibiotic therapy and six of 43 patients in the
ceftizoxime group failed (p = 0.399). In the univariate analysis, abdominal
wound infection (p = 0.003) and higher gestational age (p = 0.008) were associated with failure of the
antibiotic. With multiple logistic regression, only abdominal
wound infection was associated with failure of the
antibiotic (p = 0.0002). We conclude that
cefoxitin and
ceftizoxime are equally effective in the
therapy of postpartum
endometritis and that abdominal
wound infection is primarily responsible for persistent
fever and, therefore, failure of the
antibiotic in patients with postpartum
endometritis.