Cefamandole for treatment of obstetrical and gynecological infections

Cefamandole nafate has been shown to have good in vitro activity against a wide spectrum of aerobic and anaerobic pathogens frequently isolated from women with obstetrical and gynecological infections. One hundred and twenty seven women with these infections were treated with cefamandole: 78 had post-cesarean section metritis; 24 acute pelvic inflammatory disease; 18 post-hysterectomy cuff cellulitis/abscess; and 7 had vulvar or abdominal wound abscesses. All but 13% of these women had either polymicrobial aerobic/anaerobic bacterial infections, or had an anaerobic infection alone. Of these 127 women, 116 responded to cefamandole administration alone, and in the other 11 chloramphenicol was added. Of these 11, surgical therapy was necessary to eradicate infection in six women. Phlebitis, mild to severe, was demonstrated in 14% of the women and responded to conservative measures. Of 402 bacterial isolates from these women, 94% were sensitive to cefamandole at 32 μg/ml, an easily achievable serum level. Anaerobic streptococci were the most common isolate and 94% of these organisms were sensitive at 32 μg/ml. Of the 43 Bacteroides species isolated 90% were susceptible at 32 μg/ml; 84% of cefamandole given alone is safe and effective for treatment of women with polymicrobial mixed aerobic/anaerobic pelvic infections and ~5% will require surgical therapy for eradication of these infections.