Microbiologic considerations in the treatment of serious pelvic infections in women.

Antibiotic therapy in the woman with suspected pelvic inflammatory disease (PID) may often be empiric. Thus, an understanding of the microbiology of the female genital tract is important in the informed selection of therapy for PID. Chlamydia trachomatis plays an important role in PID, and tetracycline and erythromycins are the agents most active against those infections. Neisseria gonorrhoeae is also an important pathogen in PID, particularly in a lower socioeconomic, urban setting. The treatment regimens currently recommended for penicillinase-producing N gonorrhoeae are spectinomycin and a broad-spectrum cephalosporin. Other bacterial flora of the female genital tract, including the facultative enteric bacilli, gram-positive aerobes and anaerobes, play an important pathogenic role in PID. Among the broad-spectrum cephalosporins, ceftizoxime has been shown to possess greater activity against isolates of the Bacteroides fragilis group and enteric bacilli than do the related agents, cefoxitin and cefotetan.