RESUMEN
OBJECTIVE: Elaboration of an empiric antibiotic regimen for women with pelvic inflammatory disease (PID) for a geographical area in eastern Hungary. STUDY DESIGN: Pathogens were identified by culturing or polymerase chain reaction (PCR) from 2215 patients with suspected PID between 1 January 1999 and 31 December 2001. Empiric guidelines for PID treatment were based on susceptibility testing of the recovered bacteria, patient acceptance and cost-effectiveness of drugs and recommendations of earlier studies. RESULTS: Chlamydia trachomatis was detected in 11%, Neisseria gonorrhoeae in 2%, Streptococcus spp. in 17%, Enterococcus spp. 9%, genital mycoplasmas in 25%, all obligate anaerobic pathogens in 30% of the patients. All antibiotics chosen for our regimen were effective in vitro against one or more recovered pathogens at least in 80%; this regimen produced 98% clinical cure rate in mild cases of PID. CONCLUSION: Early detection and prompt empirical antimicrobial therapy adapted to the local microflora and its resistance pattern can lead to good clinical results.
Asunto(s)
Antibacterianos/uso terapéutico , Enfermedad Inflamatoria Pélvica/tratamiento farmacológico , Enfermedad Inflamatoria Pélvica/microbiología , Adolescente , Adulto , Chlamydia trachomatis/efectos de los fármacos , Chlamydia trachomatis/aislamiento & purificación , Enterococcus/efectos de los fármacos , Enterococcus/aislamiento & purificación , Femenino , Humanos , Hungría , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Mycoplasma/efectos de los fármacos , Mycoplasma/aislamiento & purificación , Neisseria gonorrhoeae/efectos de los fármacos , Neisseria gonorrhoeae/aislamiento & purificación , Peptostreptococcus/efectos de los fármacos , Peptostreptococcus/aislamiento & purificación , Reacción en Cadena de la Polimerasa , Streptococcus/efectos de los fármacos , Streptococcus/aislamiento & purificaciónRESUMEN
The in vitro and in vivo effectiveness of amikacin, cefepime, and imipenem was studied using a high inoculum of an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain. An in vitro susceptibility test at the standard inoculum predicted the in vivo outcome of amikacin or imipenem while it did not do so for cefepime due to the inoculum effect.