From the FDA Drug Label
Ertapenem was evaluated in adults for the treatment of acute pelvic infections in a randomized, double-blind, non-inferiority clinical trial. This trial compared ertapenem (1 g intravenously once a day) with piperacillin/tazobactam (3. 375 g intravenously every 6 hours) for 3 to 10 days and enrolled 412 patients including 350 patients with obstetric/postpartum infections and 45 patients with septic abortion. The clinical success rates in the clinically evaluable population at 2 to 4 weeks posttherapy (test-of-cure) were 93.9% (153/163) for ertapenem and 91. 5% (140/153) for piperacillin/tazobactam.
The best antibiotic for postop day 6 gyn surgery abscess is Ertapenem.
- Key points:
- Ertapenem has been evaluated for the treatment of acute pelvic infections, including post-surgical gynecological infections.
- Clinical success rates for ertapenem were 93.9% in the clinically evaluable population.
- Ertapenem is indicated for the treatment of adult patients with acute pelvic infections, including postpartum endomyometritis, septic abortion, and post-surgical gynecological infections 1.
From the Research
For a postoperative day 6 gynecological surgery abscess, empiric broad-spectrum antibiotic therapy with cefazolin plus metronidazole would be an appropriate first-line treatment, as it has been shown to reduce infectious morbidity compared to cefazolin or second-generation cephalosporins alone 2. This recommendation is based on the most recent and highest quality study available, which demonstrated the effectiveness of cefazolin plus metronidazole in reducing surgical site infections after hysterectomy 2. Some key points to consider when treating a postoperative gynecological surgery abscess include:
- The polymicrobial nature of gynecological abscesses, which typically involve aerobic and anaerobic bacteria including Streptococci, E. coli, Bacteroides, and Peptostreptococcus
- The importance of surgical drainage of the abscess in addition to antibiotic therapy
- The need to narrow antibiotic therapy based on culture results and susceptibility testing once available
- The typical treatment duration of 7-14 days, with transition to oral antibiotics when the patient shows improvement
- The importance of close monitoring for signs of improvement, including decreasing pain, fever resolution, and normalization of inflammatory markers It's worth noting that other antibiotic regimens, such as clindamycin plus gentamicin or piperacillin-tazobactam, may also be effective in treating postoperative gynecological surgery abscesses 3, 4, 5, 6. However, the combination of cefazolin plus metronidazole is supported by the most recent and highest quality evidence 2.