Seventy patients with postpartum
endomyometritis were treated with either intravenous
mezlocillin (16 gm/day) or
ampicillin (8 gm/day) in a prospective, randomized, double-blind comparison. Endocervical dilatation was routinely performed.
Clindamycin (2 gm/day) was added if patients failed to improve within 48 hours of beginning
therapy. Pretreatment clinical and microbiologic profiles were comparable in the two groups.
Bacteremia was documented in 21 patients (30%). Anaerobic cocci and Bacteroides spp. (non-B. fragilis) comprised 19 of 29 (65%) blood isolates. Thirty of 33
mezlocillin-treated patients (91%) and 30 of 37
ampicillin-treated patients (81%) responded to initial
therapy (P greater than 0.4). Resolution was noted after the addition of
clindamycin in all ten nonresponders; two of these patients also required
surgical wound debridement. Objective parameters of clinical response were not significantly different in the two treatment groups. Side effects of
mezlocillin therapy were minimal. We conclude that
mezlocillin and
ampicillin are equally effective and safe for
therapy of postpartum
endomyometritis. That
mezlocillin was not superior to
ampicillin, despite expanded activity against B. fragilis and members of Enterobacteriaceae, suggests that these pathogens are less important than was previously considered in postpartum
endomyometritis.