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Biomedical subjects

R L Sweet

Publications and source records attributed to R L Sweet.

At least 55 records · Page 3Linked to original sources
PubMed1993

New approaches for the treatment of bacterial vaginosis.

OBJECTIVE: Review alternative approaches to oral metronidazole for the treatment of bacterial vaginosis. STUDY DESIGN: Assessment of clinical trials on the treatment of bacterial vaginosis with regimens other than 5 to 7 days of metronidazole. RESULTS: Single-dose metronidazole, 2 gm orally, is as effective as 5- to 7-day courses of oral metronidazole, with cure rates in the 80% to 90% range. Oral clindamycin results in more than a 90% clinical cure rate. Intravaginal clindamycin cream 2% and intravaginal metronidazole gel 0.75% are associated with clinical cure rates similar to those for oral metronidazole. CONCLUSIONS: Single-dose metronidazole, oral clindamycin, intravaginal clindamycin cream, and intravaginal metronidazole gel are effective and safe alternatives to a 5- to 7-day course of oral metronidazole for the treatment of bacterial vaginosis.

Administration, Intravaginal↗
PubMed1993

Outpatient parenteral antibiotic therapy. Management of serious infections, Part II: Amenable infections and models for delivery. Pelvic inflammatory disease.

Due to its polymicrobial origins and potential for causing infertility and ectopic pregnancy, pelvic inflammatory disease (PID) is a particularly challenging infection to treat. Treatment of mild PID has long been standardized: a single dose of an IM antibiotic followed by oral therapy. Patients with advanced PID requiring long-term therapy may be candidates for outpatient parenteral therapy.

Ambulatory Care↗
PubMed1993

Pelvic inflammatory disease: metaanalysis of antimicrobial regimen efficacy.

An extensive body of literature has investigated the efficacy of antimicrobial regimens used to treat pelvic inflammatory disease (PID), leaving many clinicians confused about how to choose among them. This study provides a formal appraisal of these reports. Thirty-four treatment studies published between 1966 and 1992 were identified, using Medline and bibliographies, and evaluated qualitatively and quantitatively in a metaanalysis. Twenty-one studies met the criteria for inclusion in this evaluation: appropriate system for making the diagnosis of PID, standardized assessment of clinical outcome, and entry and follow-up evaluation for lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis. This metaanalysis identifies a considerable range of quality in study methods and research design and underscores the limitations inherent in comparing such data. Despite this, a number of antimicrobial regimens appear to have very good short-term clinical and microbiologic efficacy. Pooled clinical cure rates range from 75% to 94% and pooled microbiologic cure rates range from 71% to 100%. A cost comparison is provided, and future research priorities are suggested.

Adolescent↗
PubMed1993

Progress in the management of tuboovarian abscesses.

The last 20 years have witnessed remarkable improvements in the treatment of tuboovarian abscesses. Gone are the days of significant mortality associated with ruptured and unruptured TOAs. Broad-spectrum antibiotics have enabled patients to be treated solely with medical therapy, avoiding the need for surgery. Operative intervention is still necessary in 25% of cases of unruptured TOAs, but the combination of conservative surgical procedures, such as unilateral salpingo-oophorectomy, and broad-spectrum antimicrobial agent therapy have reduced the need for total abdominal hysterectomy with bilateral salpingo-oophorectomy greatly. Although fertility after TOAs is compromised significantly, new advances in reproductive technology, including in vitro fertilization and donor egg transplantation, represent reproductive options for these women. Percutaneous drainage and laparoscopic treatment of TOAs are becoming popular treatment options, but prospective studies urgently are needed to assess their efficacy.

Abscess↗
PubMed1993

Pelvic inflammatory disease in human immunodeficiency virus-infected women.

OBJECTIVE: To determine whether the clinical course of pelvic inflammatory disease differs between women with human immunodeficiency virus (HIV) infection and seronegative controls. METHODS: All admissions for acute pelvic inflammatory disease from January 1, 1986 to December 31, 1992 at San Francisco General Hospital were reviewed, identifying 23 HIV-seropositive women. Their clinical course was compared with a control group of 108 seronegative women admitted for acute pelvic inflammatory disease. RESULTS: Human immunodeficiency virus-seropositive women with acute pelvic inflammatory disease had significantly lower abdominal tenderness scores (P < .05), lower admission and discharge white blood cell counts (WBC) (P < .01, P < .05), and fewer gonococcal infections (odds ratio 0.3, 95% confidence interval [CI] 0.1-0.9; P < .05) than the seronegative controls. There were no significant differences in duration of treatment, length of hospitalization, or incidence of tubo-ovarian abscess. Significantly more HIV-positive women with acute pelvic inflammatory disease required surgical intervention than seronegative women (odds ratio 5.5, 95% CI 1.0-29.3; P < .05). CONCLUSION: Human immunodeficiency virus-seropositive women with acute pelvic inflammatory disease may have an altered immune response, resulting in inadequate response to antimicrobial agents and the need for more surgical intervention. Future studies must include larger numbers of HIV-infected women, and the results must be stratified for CD4 counts, clinical HIV stage, and other measures of immunocompromise.

Adult↗
PubMed1992

A review of premature birth and subclinical infection.

Premature birth causes high rates of neonatal morbidity and mortality. There are multiple causes of preterm birth. This article reviews the evidence linking subclinical infection and premature birth. Although maternal genital tract colonization with specific organisms has been inconsistently associated with preterm birth and/or premature rupture of membranes, some infections have been consistently associated with preterm delivery. The association of histologic chorioamnionitis with prematurity is a consistent finding, but the mechanisms require further study. The relationship between histologic chorioamnionitis infection and the chorioamnionitis of prematurity requires additional research. A varying number of patients in "idiopathic" preterm labor have positive amniotic fluid cultures (0% to 30%), but it is not clear whether infection preceded labor or occurred as a result of labor. Evidence of subclinical infection as a cause of preterm labor is raised by finding elevated maternal serum C-reactive protein and abnormal amniotic fluid organic acid levels in some patients in preterm labor. Biochemical mechanisms for preterm labor in the setting of infection are suggested by both in vitro and in vivo studies of prostaglandins and their metabolites, endotoxin and cytokines. Some, but by no means all, antibiotic trials conducted to date have reported decreases in prematurity. These results support the hypothesis that premature birth results in part from infection caused by genital tract bacteria. In the next few years, research efforts must be prioritized to determine the role of infection and the appropriate prevention of this cause of prematurity.

Anti-Bacterial Agents↗
PubMed1992

Long-term sequelae of acute pelvic inflammatory disease. A retrospective cohort study.

OBJECTIVE: Our objective was to prospectively assess the frequency and predictors of long-term sequelae of acute pelvic inflammatory disease. STUDY DESIGN: We performed a retrospective cohort study of 140 women admitted for treatment of pelvic inflammatory disease to San Francisco General Hospital in 1985, locating and interviewing 51 women by telephone a median of 37 months later. RESULTS: Twelve (24%) women had pelvic pain for 6 months or more after hospitalization, 22 (43%) had subsequent episode(s) of pelvic inflammatory disease, and 40% were involuntarily infertile. A history of pelvic inflammatory disease prior to admission was associated with infertility (p = 0.05), chronic pelvic pain (p = 0.03), and pelvic inflammatory disease subsequent to hospitalization (p = 0.06). Longer duration of abdominopelvic pain before admission and younger age at the time of first sexual intercourse were associated with both infertility (p = 0.02, p = 0.04) and subsequent pelvic inflammatory disease (p = 0.04, p = 0.0008). CONCLUSIONS: Further studies are needed to more accurately assess the incidence and predictors of long-term sequelae of pelvic inflammatory disease. A reduction in adverse outcome will require more stringent efforts at education and reduction of risk-taking behaviors.

Acute Disease↗
PubMed1992

Comparison of rapid tests for detection of group B streptococcal colonization.

Accurate rapid detection of maternal lower genital tract colonization with group B streptococci (GBS) in high-risk patients is essential for selective institution of intrapartum antibiotic treatment to reduce neonatal GBS infection. In this study, pure GBS isolates were used to evaluate five commercially available rapid tests in terms of speed, ease of use, and sensitivity. The products tested were Directigen, Equate, Bactigen, PathoDx, and Phadebact. Although each test could be performed relatively quickly, the ease of performance and level of sensitivity (10(5) to 10(8) CFU/ml) varied markedly. Quantitative cultures obtained from 17 known GBS carriers showed concentrations ranging from less than 10(2) to greater than 10(8) CFU/gm of vaginal material. Since only 40% of the women had greater than or equal to 10(5) CFU/gm of vaginal material, it appears that many colonized women would not be identified by these rapid tests.

Bacteriological Techniques↗
PubMed1992

Evaluation of new anti-infective drugs for the treatment of acute pelvic inflammatory disease. Infectious Diseases Society of America and the Food and Drug Administration.

Pelvic inflammatory disease (PID) is a syndrome unrelated to pregnancy or surgery and characterized by lower abdominal pain and tenderness, cervical motion tenderness, and adnexal tenderness. Fever, leukocytosis, and the results of laboratory tests are used to support the diagnosis. Participants in clinical trials should be stratified into two groups: those with and those without tubo-ovarian abscess--i.e., those with complicated and those with uncomplicated PID. Diagnostic studies and treatment should be directed at four major groups of pathogens: Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, and facultative bacteria such as Escherichia coli. Women requiring hospitalization should generally be treated as inpatients for at least 4-7 days; outpatient therapy should then be instituted to complete a 14- to 21-day course. Clinical and laboratory evaluations should be conducted daily during hospitalization and both 2-4 days and 2-4 weeks after the completion of therapy.

Acute Disease↗
PubMed1992

AIDS (HIV) risk assessment in an inner-city women's clinic.

Risk assessment and antibody testing are potential modalities through which interventions to reduce heterosexual and perinatal transmission of human immunodeficiency virus (HIV) can occur. More than 98% of women attending inner-city adult gynecology, adult contraception and teen family planning clinics successfully completed self-administered HIV (AIDS) risk assessment questionnaires and received individual counseling, risk-reduction education and referral for antibody testing. Fourteen percent of the women (671/4,802) reported at least one HIV risk factor. Multiple sexual partners and intravenous drug use were the most commonly reported HIV risk factors in this population.

AIDS Serodiagnosis↗
PubMed1991

Diagnosing pelvic inflammatory disease. A comprehensive analysis and considerations for developing a new model.

OBJECTIVE: --To examine the accuracy of existing diagnostic indicators for pelvic inflammatory disease and to develop guidelines for a new diagnostic model. DATA SOURCES: --Studies were identified for the period 1969 through 1990. A Medline search of the English-language literature was conducted using the subject terms pelvic inflammatory disease or salpingitis and diagnosis. In addition, abstracts and bibliographies of articles and books were reviewed. STUDY SELECTION: --Studies were selected if pelvic inflammatory disease was diagnosed using laparoscopic findings or narrow clinical rules. Of the 15 reports identified, 12 were included in this analysis. The selected studies were grouped by a quality rating based on subject selection, definition of pelvic inflammatory disease, data analysis, and other measures. DATA EXTRACTION: --Diagnostic findings were divided into four categories: historical (symptoms), clinical examination (signs), laboratory, and combinations of the above. Sensitivity and specificity were extracted using raw data. Data were classified by quality rating. DATA SYNTHESIS: --Historical findings were usually not statistically significant predictors of pelvic inflammatory disease, and when they were they tended toward low sensitivity and high specificity, while clinical findings were somewhat more sensitive and about as specific. Several laboratory tests showed consistent value in pelvic inflammatory disease diagnosis, with high sensitivity and specificity. Combinations of indicators permitted high sensitivity or high specificity but not both simultaneously. CONCLUSIONS: --No single or combination diagnostic indicator was found to reliably predict pelvic inflammatory disease. Combining published evidence with practical clinical considerations, a diagnostic approach is proposed that emphasizes diagnostic sensitivity when clinical presentation is mild and more thorough evaluation when a woman is severely ill. Research is needed to evaluate the accuracy and acceptability of specific diagnostic models and to investigate new diagnostic indicators.

Female↗
PubMed1991

Vertical transmission of hepatitis C virus.

There is evidence that hepatitis C virus (HCV) may be vertically transmitted from infected mothers to their children. To test this hypothesis, we prospectively studied 10 pregnant women at high risk from parenterally or sexually transmitted diseases with the polymerase chain reaction. HCV RNA was found in 8 newborn babies delivered by women who were anti-HCV seropositive, and persisted for 2-19 months of follow-up. Anti-HCV detected in 7 infants cleared by 9 months and remained undetectable thereafter. Serum alanine aminotransferase was raised in 3 infants. The findings provide evidence of vertical transmission of HCV and suggest that perinatal infection may initiate a silent disease process or chronic carrier state.

Alanine Transaminase↗
PubMed1991

Antibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens.

One hundred nineteen patients with tuboovarian abscess were evaluated for response to antibiotics. Results were stratified into three groups by antimicrobial regimen. Group 1 consisted of 37 patients treated with a single-agent broad-spectrum intravenous antibiotic and oral doxycycline. Initial clinical response (defined as decreased pain, diminished white blood cell count, or defervescence) in group 1 was 31/37 (84%). Group 2 consisted of 64 patients treated with clindamycin in combination with an aminoglycoside with or without a penicillin. There was an initial clinical response in 45 of 64 (70%). Group 3 consisted of 18 patients from group 1 who were changed to a clindamycin-containing regimen after 2 to 3 days of initial treatment with a single-agent broad-spectrum antibiotic. The decision to switch antibiotics was not based on treatment failure but occurred when delayed ultrasonography confirmed the diagnosis of tuboovarian abscess. The switch reflected physician preference for clindamycin-containing regimens in the treatment of tuboovarian abscesses. The response rate in this subset of patients was 14 of 18 (78%). Overall initial clinical response rate was 90 of 119 (75%). There were no statistically significant demographic or clinical differences among the three groups. There was no statistical difference in the rate of early and late antibiotic failure rates among the groups. Our study demonstrates that extended-spectrum antibiotic coverage, including single-agent broad-spectrum antibiotics such as cefoxitin, in conjunction with doxycycline has efficacy that is equivalent to that of clindamycin-containing regimens. An overall medical treatment success rate of 75% suggests that conservative treatment of tuboovarian abscesses is warranted.

Abscess↗
PubMed1990

The association between Chlamydia trachomatis and ectopic pregnancy. A matched-pair, case-control study.

We performed a case-control study of the association of past exposure to Chlamydia trachomatis and ectopic pregnancy with 306 case patients with an ectopic pregnancy and 266 pregnant patients who served as controls. The geometric mean antichlamydial antibody titer among cases was 75 +/- 10.2 vs 13 +/- 11.0 among controls. The matched-pair odds ratio for ectopic pregnancy and IgG titer of 1:64 or greater to C trachomatis was 3.0 (95% confidence interval, 2.1 to 4.4). Adjusting for age at first intercourse, total lifetime partners, douching, history of infertility, and parity yielded a relative risk of 2.4 (95% confidence interval, 1.5 to 3.3). Current douching remained an independent risk factor after controlling for chlamydial exposure, with an adjusted relative risk of 2.1 (95% confidence interval, 1.3 to 3.5). The population attributable fraction for chlamydial infection was 0.47 and that for douching was 0.45. The results stress the need for control of C trachomatis infections and for further study of specific douching behaviors as risk factors for ectopic pregnancy.

Adult↗
PubMed1990

Role of cephamycins in obstetrics and gynecology.

Infections of the female upper genital tract are usually polymicrobic, often involving mixed aerobic (facultative) and anaerobic bacteria. Optimal therapy provides coverage against aerobes (both gram positive and gram negative and especially the Enterobacteriaceae) and anaerobes (especially the beta-lactamase-producing gram-negative species, such as Bacteroides). A variety of antibiotics provide the broad spectrum of activity needed for these infections, including clindamycin plus an aminoglycoside, cephalosporins and cephamycins, imipenem, extended-spectrum penicillins and the beta-lactam agents combined with a beta-lactamase inhibitor. The cephamycins--cefoxitin, cefotetan and cefmetazole--have been shown to have a high rate of clinical efficacy and bacteriologic response. The cephalosporins are usually used for prophylaxis at the time of obstetric and gynecologic surgery. The cephamycins have recently undergone extensive evaluation for prophylaxis and have demonstrated comparable microbiologic and clinical efficacy. A pharmacokinetic comparison of cefoxitin, cefotetan and cefmetazole points to cefmetazole as a cost-effective alternative to cefoxitin and cefotetan for both prophylaxis and treatment of pelvic infections.

Bacterial Infections↗