MEDICALLY SOUND, COST-EFFECTIVE TREATMENT FOR PELVIC INFLAMMATORY DISEASE AND TUBOOVARIAN ABSCESS

OBJECTIVE: Our purpose was to determine the clinical effectiveness and cost-effectiveness of three antibiotic regimens for the treatment of pelvic inflammatory disease and tuboovarian abscess. STUDY DESIGN: A r eview of all patients' hospitalized at Hutzel Hospital, Detroit, Michi gan, for treatment of pelvic inflammatory disease and tuboovarian absc ess between Jan. 1, 1993, and April 30, 1997, was performed. Demograph ic data, antibiotic choices, changes in therapy, operative interventio ns, and cost of therapy were assessed. RESULTS: Two hundred three pati ents were admitted for treatment of pelvic inflammatory disease during the study period. We were able to evaluate the clinical efficacy of a ntibiotic treatment in 179 patients, including 105 patients with pelvi c inflammatory disease alone (uncomplicated pelvic inflammatory diseas e) and 74 women whose infection was complicated by tuboovarian abscess . The three antibiotic regimens evaluated were cefotetan plus doxycycl ine, clindamycin plus gentamicin, and ampicillin plus clindamycin plus gentamicin. All regimens demonstrated comparable efficacy in treating uncomplicated genital tract infections. Ampicillin plus clindamycin p lus gentamicin was significantly better than clindamycin plus gentamic in and cefotetan plus doxycycline in treatment of tuboovarian abscess (p = 0.001). Fifteen women with tuboovarian abscess responded to a cha nge to ampicillin plus gentamicin plus clindamycin antibiotic therapy alone. The hospital stay was prolonged by approximately 3 days in wome n failing to respond to initial antibiotic therapy, and operative inte rventions were common in this group of patients. CONCLUSIONS: Cefoteta n plus oral doxycycline is the most cost-effective regimen for treatin g uncomplicated pelvic inflammatory disease, whereas triple-antibiotic therapy is the treatment of choice in women with tuboovarian abscess.