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Biomedical subjects

R L Sweet

Publications and source records attributed to R L Sweet.

At least 73 records · Page 4Linked to original sources
PubMed1990

Seroprevalence and epidemiologic correlates of human immunodeficiency virus infection in women with acute pelvic inflammatory disease.

As the number of women with acquired immunodeficiency syndrome (AIDS) continues to rise in the United States, it becomes important to target preventive interventions as effectively as possible toward those groups at highest risk of acquiring human immunodeficiency virus (HIV) infection. We analyzed the prevalence of serum antibody to HIV in 333 women admitted to the Gynecology Service at San Francisco General Hospital with acute pelvic inflammatory disease in the years 1985-1988. The proportion of women with HIV infection in our sample rose incrementally over this 4-year period, from 0 to 6.7%. A history of intravenous (IV) drug use conferred a 23-fold risk of HIV seropositivity. In contrast, markers of the level of sexual activity did not correlate significantly with the presence of HIV infection, although the power to detect such an association was limited by the small sample size. An intensification of educational efforts directed at IV drug-using women in San Francisco is necessary to prevent further increases in the rate of HIV infection and further spread into the heterosexual population.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Amoxicillin therapy for Chlamydia trachomatis in pregnancy.

For treating Chlamydia trachomatis cervical infection in pregnancy, the Centers for Disease Control guidelines recommend either erythromycin base or erythromycin ethylsuccinate. There is no alternate therapy. Because of compliance problems with erythromycin regimens due to gastrointestinal side effects, such an alternative is needed. For this reason, we compared, in an open trial, the efficacy and patient compliance of amoxicillin (500 mg three times a day for 7 days) with those of erythromycin base (500 mg four times a day for 7 days) in treating C trachomatis cervical infections during pregnancy. In the amoxicillin group, 63 of 64 women (98.4%) had negative cervical cultures after treatment, compared with 55 of 58 women (94.8%) treated with erythromycin base. Vertical transmission to the infants was assessed by culture and/or persistent or rising immunoglobulin G antichlamydial antibody. In the amoxicillin group, 37 of 39 infants (94.9%) had no evidence of chlamydial infection, compared with 32 of 36 infants (88.8%) in the erythromycin group. These differences were not significant. The frequency of side effects was higher with erythromycin base than with amoxicillin (15 versus 8%), although not significantly so. However, the frequency of stopping medication because of side effects was significantly higher with erythromycin base than with amoxicillin (13 versus 2%; P less than .006). These results suggest that amoxicillin may be an acceptable alternative treatment for chlamydial infections in pregnancy.

Adult↗
PubMed1989

Efficacy of single-agent therapy for the treatment of acute pelvic inflammatory disease with ciprofloxacin.

A prospective, randomized, controlled, non-blind clinical trial was conducted to compare the efficacy of monotherapy with ciprofloxacin with that of a combination of clindamycin plus gentamicin in the treatment of patients with acute pelvic inflammatory disease. Pretreatment and post-treatment cervical culture specimens were obtained for Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum. Pretreatment and post-treatment endometrial culture specimens were obtained for those organisms plus facultative and anaerobic bacteria. Minimal inhibitory concentrations were determined on all isolates by agar dilution. Clinical resolution of infection was seen in 31 of 33 (94 percent) ciprofloxacin-treated patients compared with 34 of 35 (97 percent) clindamycin/gentamicin-treated patients. N. gonorrhoeae was eradicated in all cases and C. trachomatis in 12 of 13 cases (92 percent). Ciprofloxacin appeared less effective than clindamycin/gentamicin in eradicating bacterial-vaginosis-associated organisms from post-treatment culture specimens obtained from the endometrium. Comparable clinical response was seen with both regimens. The significance of persistent bacterial-vaginosis-associated organisms following ciprofloxacin therapy is unclear. However, since one goal of treatment of pelvic inflammatory disease should be to eliminate organisms from the upper genital tract, ciprofloxacin may not provide optimal single-agent therapy for pelvic inflammatory disease.

Acute Disease↗
PubMed1989

Sulbactam/ampicillin in the treatment of acute pelvic inflammatory disease.

Acute pelvic inflammatory disease is associated with significant adverse reproductive sequelae. To prevent these serious sequelae, treatment regimens must cover the major etiologic agents which are Neisseria gonorrhoeae, Chlamydia trachomatis, and mixed anaerobic-aerobic bacteria. This report concerns the prospective evaluation of the efficacy of the combination of sulbactam with ampicillin in patients hospitalized with acute pelvic inflammatory disease. Clinical cure was noted in 33 (94%) of 35 patients and post-treatment cultures demonstrated eradication of N. gonorrhoeae and C. trachomatis in all cases.

Adult↗
PubMed1989

Prophylaxis in caesarean section with cefmetazole and cefoxitin.

A prospective, randomized, open comparison of three 1 g doses of cefmetazole with three 2 g doses of cefoxitin for non-elective Caesarean section was performed. Sixty-nine patients were evaluated. The two groups were comparable with respect to labour characteristics that might influence risk of postoperative infectious morbidity. Similarly, the nature of the bacterial contamination/infection of the amniotic fluid at the time of Caesarean section was comparable in the two groups. The only infectious morbidity noted was endomyometritis. The incidence was the same in both groups, 5/50 (10%) in the cefmetazole group and 2/19 (10.5%) in the cefoxitin group. Febrile morbidity, as reflected in the fever index, was not significantly different between the groups, 10.2 +/- 18.5 degree hours in the cefmetazole group and 7.5 +/- 11.7 degree hours in the cefoxitin group. Cefmetazole appeared to be equivalent to cefoxitin in reducing post-Caesarean section endomyometritis.

Adolescent↗
PubMed1989

Routine intraoperative ultrasonography for second trimester abortion reduces incidence of uterine perforation.

Second trimester elective abortion is safest when accomplished with cervical dilation and instrumental uterine evacuation (D and E), but this procedure carries with it a risk of uterine perforation and possible intra-abdominal trauma. In order to determine if the routine use of intraoperative ultrasonography reduces the risk of this feared and serious complication, 353 elective abortions at 16 to 24 weeks gestation performed without sonography were compared to 457 in which sonography was routinely employed. All 810 operations were carried out in one clinic using the same operative technique. The routine intraoperative use of ultrasonographic imaging to guide intrauterine forceps during uterine evacuation for second trimester elective abortion resulted in a significant reduction in uterine perforation, the rate declining from 1.4% to .2%. These findings support the routine use of intraoperative ultrasonography for second trimester elective abortion to reduce the incidence of uterine perforation and make the procedure a safer one.

Abortion, Induced↗
PubMed1989

Vaginal douching as a possible risk factor for pelvic inflammatory disease.

To prevent pelvic inflammatory disease (PID) and its consequences, risk factors must be identified. A review of the literature supports the possibility that vaginal douching may affect the risk factor of PID, and new data are presented on douching practices of women hospitalized with PID. Individual case reports and controlled studies support associations between vaginal douching and both PID and ectopic pregnancy. The prevalence and distribution of douching are also compatible with a possible association. The temporal pattern of PID symptoms may be linked to douching and menses. The nature of the douche solution and the douching technique may be important variables with regard to douching as a PID risk factor. A case-control epidemiologic study is recommended to clarify the relationships between PID and douching.

Female↗
PubMed1988

Multicenter clinical trials comparing cefotetan with moxalactam or cefoxitin as therapy for obstetric and gynecologic infections.

The clinical efficacy and safety of cefotetan was assessed in two multicenter clinical trials involving 335 evaluable patients hospitalized with obstetric and gynecologic infections. In Study I, cefotetan was compared with moxalactam and in Study II, cefotetan was compared with cefoxitin. The clinical response rate in Study I was 67 of 70 patients for cefotetan (96 percent) and 33 of 34 patients (97 percent) for moxalactam. In Study II, the clinical response rate was 138 of 147 patients in the cefotetan group (94 percent) and 76 of 84 patients in the cefoxitin group (91 percent). For the patients with bacteriologic response data, 196 of 205 cefotetan patients (96 percent), 23 of 24 moxalactam patients (96 percent), and 70 of 75 cefoxitin patients (93 percent) had a satisfactory bacteriologic response. Cefotetan was well tolerated and produced no major adverse reactions. The mean amount of cefotetan given was lower than that of moxalactam or cefoxitin.

Adult↗
PubMed1988

Ambulatory treatment of suspected pelvic inflammatory disease with Augmentin, with or without doxycycline.

Sixty-three women with suspected pelvic inflammatory disease were treated as outpatients with Augmentin with or without doxycycline. Initially, doxycycline was added only after a direct test for Chlamydia trachomatis was positive. Because chlamydial infections were frequent, all patients received doxycycline during the last two thirds of the study. Neisseria gonorrhoeae or Chlamydia trachomatis were recovered from 15 (65%) of 23 women classified as probably having pelvic inflammatory disease. Among 47 women reexamined after starting therapy, three rapidly became worse and were hospitalized, nine (20%) discontinued therapy because of gastrointestinal side effects, and all of the remaining 35 women who completed therapy were either cured or improved.

Adult↗
PubMed1988

Multicenter comparison of cefotetan and cefoxitin in the treatment of acute obstetric and gynecologic infections.

Two hundred eighty-seven women were treated in a multicenter, randomized, comparative study to compare the safety and efficacy of cefotetan every 12 hours with that of cefoxitin every 6 or 8 hours in the treatment of acute obstetric and gynecologic pelvic infections. The most frequent primary diagnoses in both groups were endometritis and pelvic inflammatory disease; 24 of these patients were also bacteremic. The mean duration of treatment was 5.2 and 5.4 days for the cefotetan and cefoxitin groups, respectively, and the total doses administered were 18.1 and 32.1 gm, respectively. The rate of clinical failure for the cefotetan group was 8.5% and 12.2% for the cefoxitin group. Laboratory and clinical adverse reactions were infrequent and none was serious; both antimicrobials were well tolerated. These results suggest the administration of cefotetan provided adequate clinical and bacteriologic effectiveness in the treatment of hospital- and community-acquired, polymicrobial obstetric and gynecologic pelvic infections.

Acute Disease↗
PubMed1988

Treatment of hospitalized patients with acute pelvic inflammatory disease: comparison of cefotetan plus doxycycline and cefoxitin plus doxycycline.

Acute pelvic inflammatory disease remains the major medical and economic consequence of sexually transmitted diseases among young women. The polymicrobial origins of pelvic inflammatory disease have been well documented and the major organisms recovered from the upper genital tract in patients with pelvic inflammatory disease include Chlamydia trachomatis, Neisseria gonorrhoeae, and mixed anaerobic and aerobic bacteria. This study was undertaken to compare the efficacy and safety of cefotetan plus doxycycline with that of cefoxitin plus doxycycline in the treatment of hospitalized patients with acute pelvic inflammatory disease. A total of 68 hospitalized patients with acute pelvic inflammatory disease were entered and randomized into two treatment groups: cefotetan (n = 32) and cefoxitin (n = 36). There were six tuboovarian abscesses in each group. C. trachomatis was recovered from 7 (10%) and N. gonorrhoeae from 48 (71%) of the patients. Anaerobic and aerobic bacteria were recovered from the upper genital tract in 53 (78%) of the patients. Cefotetan plus doxycycline and cefoxitin plus doxycycline demonstrated high rates of initial clinical response in the treatment of acute pelvic inflammatory disease. Clinical cure was noted in 30 (94%) of the cefotetan plus doxycycline group and 33 (92%) of the cefoxitin plus doxycycline group. Four failures were sonographically diagnosed tuboovarian abscesses that responded to clindamycin plus gentamicin therapy. The fifth failure was an uncomplicated case that did not respond to cefoxitin and doxycycline and required additional therapy. At 1 week and 3 weeks, respectively, the posttreatment cultures demonstrated eradication, in all instances, of N. gonorrhoeae and C. trachomatis. These regimens also were very effective in eradicating anaerobic and aerobic pathogens from the endometrial cavity. Both regimens were well tolerated by the patients, and few adverse drug affects were noted.

Acute Disease↗
PubMed1988

Isolation of Chlamydia trachomatis from sexually abused female adolescents.

Cultures for Chlamydia trachomatis were obtained from 127 female adolescents (13-17 years of age) evaluated for reported sexual abuse. The rate of positive cultures for C trachomatis in this population was 14% (18 of 127). Neisseria gonorrhoeae was found in 12% (15 of 127) of these patients. All but two of the culture-positive patients admitted sexual activity before the abuse, and it is likely that most of the infections were acquired during this previous sexual activity. Concomitant infection with N gonorrhoeae was found in seven adolescents positive for C trachomatis. No adolescents in this study exhibited a positive VDRL. Victims of abuse should be tested for both gonococcal and chlamydial infection. These data show that if antibiotic prophylaxis is used for the sexually abused adolescent, it should be directed against both C trachomatis and N gonorrhoeae.

Adolescent↗
PubMed1987

Ampicillin/sulbactam versus metronidazole-gentamicin in the treatment of soft tissue pelvic infections.

The clinical efficacy and safety of ampicillin/sulbactam versus metronidazole-gentamicin were evaluated in a comparative, randomized, prospective study. Forty-four patients were enrolled: 22 received the ampicillin/sulbactam regimen, and 22 received the metronidazole-gentamicin combination. There were 33 cases of severe acute pelvic inflammatory disease, two tuboovarian abscesses, five cases of endomyometritis, and two cases of posthysterectomy pelvic cellulitis. Aerobic and anaerobic cultures from the infection sites yielded 447 microorganisms from 44 patients (an average of 10 bacteria per infection; 6.4 anaerobes and 3.7 aerobes). The most frequent isolates were Bacteroides sp., 54; Bacteroides bivius, 17; black-pigmented Bacteroides, 12; Bacteroides disiens, 11; Fusobacterium, 13; Peptostreptococcus anaerobius, 24; Peptostreptococcus asaccharolyticus, 21; anaerobic gram-positive cocci, 34; Gardnerella vaginalis, 29; Neisseria gonorrhoeae, 17; alpha-hemolytic streptococci, 15; and Escherichia coli, five. Clinical cure was noted in 19 of 20 patients treated with ampicillin/sulbactam and 18 of 21 patients treated with metronidazole-gentamicin. One treatment failure occurred in the ampicillin/sulbactam group in a patient who required antichlamydial therapy and had a complex left adnexal mass consistent with an abscess. The cases of metronidazole-gentamicin failure included two patients initially diagnosed as having tuboovarian abscesses who required a change in antibiotic therapy to control the infections. The third patient had postabortion endomyometritis that did not respond to metronidazole-gentamicin therapy within 48 hours, and required a change of medication. No adverse hematologic, renal, or hepatic effects were noted in either group of patients.

Ampicillin↗
PubMed1987

Chlamydia trachomatis infection and pregnancy outcome.

Chlamydia trachomatis is now recognized as the most common sexually transmitted disease organism in the United States. Although the potential for vertical transmission of C. trachomatis from pregnant women to their infants is well established, the extent to which infection adversely affects pregnancy and causes perinatal complications remains controversial. We report herein the results of a prospective study of 270 pregnant women with endocervical C. trachomatis compared with 270 matched control subjects (age +/- 1 year, race, and socioeconomic status). Among the entire group (n = 540), the rates of pregnancy complications were: premature rupture of the membranes, 54/270 (10%); preterm delivery, 55 (11%); amnionitis, 20 (4%); intrapartum fever, 23 (4.3%); small for gestational age, 76 (14.5%); postpartum endometritis, 31 (6%); and neonatal sepsis, 10 (1.8%). No statistically significant differences were noted between cases and controls for any of these variables. In the subset of women with recent or invasive chlamydial infection, indicated by the presence of IgM antibody against C. trachomatis, preterm delivery occurred in 13/67 IgM-positive versus 8/99 IgM-negative (p = 0.03) cases. Premature rupture of the membranes was present in 13/67 IgM-positive versus 8/99 IgM-negative (p = 0.03).

Cervix Uteri↗
PubMed1987

Is there a role for Chlamydia trachomatis and genital mycoplasma in male infertility?

We believe that, without evidence of inflammation (greater than 5 WBC on VB1), there is no indication for routine culture or antibiotic treatment of infertile men. In the presence of active inflammation and positive cultures for chlamydia, treatment with antibiotics is appropriate. However, active inflammation and positive chlamydial cultures were rare findings in our population (2 of 52 and 1 of 52, respectively). Thus, we find no evidence for a role of current asymptomatic mycoplasma or chlamydial infection in male infertility.

Adult↗
PubMed1987

Cesarean section prophylaxis: comparison of two doses with three doses of mezlocillin.

A prospective randomized double-blind comparison of two doses, with three doses of mezlocillin for nonelective cesarean section prophylaxis was performed. One hundred seven (107) patients were evaluated. Mezlocillin (4 g) was given post-cord clamping and then at 4-h intervals for a total of two doses or three doses. The incidence of febrile morbidity was lower in the three-dose group (2 of 46, 4%) than the two-dose group (14 of 61, 23%) (P less than 0.02). However, the incidence of infectious morbidity was not different between the three-dose group (3 of 46, 7%) and the two-dose group (10 of 61, 16%), and the incidence of endomyometritis was similar in the two groups (6.5% vs 9.8%). Among failures of prophylaxis there were no differences compared to successes in the number of potential commensals or potential pathogens cultured from amniotic fluid. However, the proportion of failures among patients with both commensals and potential pathogens isolated (10/58) was significantly greater than among patients with none or only commensals isolated (1/37) (P less than 0.03). We found mezlocillin to be an effective agent for perioperative cesarean section prophylaxis with two doses as effective as three doses. The presence of clinically important organisms in the amniotic fluid at the time of operation typified patients with postoperative infectious complications despite perioperative prophylaxis.

Adolescent↗