Combination antimicrobial therapy for serious gynecological and obstetrical infections--obsolete?

The normal flora of the lower reproductive tract are the pathogens isolated from upper reproductive tract infections after cesarean section and hysterectomy and from intraperitoneal cultures taken from women treated for acute pelvic inflammatory disease. Because these infections are usually polymicrobial, traditional antimicrobial therapy has included various combinations of agents. During the last six years we used five different antimicrobial combinations to treat more than 600 women with one of the above infections. From 15% to 50% of cases required the addition of a third (anaerobic-specific) antimicrobial. Original therapy with clindamycin/gentamicin was unsuccessful in only 5% of the infections treated. Single-agent therapy with third-generation cephalosporins avoids most problems associated with combination therapy. Over the past 18 months we treated 237 women with cefotaxime; 94% required no further therapy.