A comparative study of moxifloxacin versus combination of doxycycline and metronidazole for treatment of uncomplicated pelvic inflammatory disease

Background: Pelvic inflammatory disease (PID), a common condition among women of reproductive age caused by various aerobic and anaerobic organisms, may sometimes lead to complications like infertility, ectopic pregnancy and chronic pelvic pain. Moxifloxacin is a broad spectrum bactericidal antibiotic acting against many gram positive, gram negative aerobic organisms and anaerobes. Rapid absorption and high bioavailability allow single daily dosing and improves compliance. The present study was done to compare the clinical and microbiological outcomes in PID patients treated with conventional doxycycline- metronidazole and moxifloxacin therapy.Methods: Women with uncomplicated PID, randomized into two groups either received 400 mg single dose of moxifloxacin daily for 14 days (group A) or doxycycline 100 mg + metronidazole 500 mg twice daily for 14 days (group B). Temperature, TLC count, ESR, CRP, microbiological assessment, Visual analogue score for pain, vaginal discharge, dyspareunia and backache were noted. The bacteriological cure was assessed by high vaginal swab for organism identification by gram stain, 10% KOH and blood sample by ELISA.Results: Total 60 women were enrolled and randomized into two groups. There was significant reduction of CRP and improved TLC in the moxifloxacin treated group. Visual analogue scores for pain, vaginal discharge and malaise were significantly reduced in the group treated with moxifloxacin. Nausea, vomiting, metallic taste, dyspepsia and diarrhoea were complained by a significant number of patients of doxycycline + metronidazole group, in contrast to the patients receiving moxifloxacin.Conclusions: Moxifloxacin 400 mg once daily, is effective and safe for treatment of PID.

Caesarean section for the dead baby--an unhappy reality.

Caesarean section for the dead baby is sometimes still needed to prevent maternal complications. The objective of the study is to critically analyse the characteristics of the mother and indications for the operation in women who delivered stillbirths following caesarean section. The study period covered a 2 years span from January, 2003 to December, 2004. During this time 121 mothers (study group) underwent caesarean section for the dead baby representing 1.41% of all caesarean section operations done in the hospital. The study group was compared to the overall caesaren section done during the two years in relation to parity (parous 77.7% versus 45.7%), type of caesarean section (emergency 83.5% versus 69.8%) and timing of caesarean section within 12 hours of admission (74.4% versus 50.2%). Common indications in the study group included antepartum haemorrhage (31.4%), malpresentation (19.0%), postcaesarean pregnancies (16.5%), obstructed labour (15.7%), foetal distress (9.9%), second twin (4.1%) and eclampsia (3.3%). In some indications like obstructed labour and malpresentation, abdominal deliveries could be reduced by more destructive operations. The maternal reasons for resorting to caesarean section to save maternal lives are understandable. But caesaren section done for foetal distress was a disturbing revealation.

Changing trends in the management of eclampsia from a teaching hospital.

Eclampsia is a major source of both maternal and perinatal mortality. In the management of eclampsia, the role of magnesium sulphate as anticonvulsant and early delivery are well established. The present study is an analysis of maternal and perinatal outcomes after the introduction of magnesium sulphate and liberalisation of caesarean section over a period from August 2002 to September 2004. The observations were compared with statistics from the same hospital from 1995-1997. The incidenceof eclampsia has remained relatively constant but postpartum cases of eclampsia have increased. The case fatality rate of eclampsia has fallen from 11.3% to 5.3%. The perinatal mortality has also fallen from 54.8% to 24.3%. The caesarean section rate for eclampsia has increased from near 10% to 49.7%. Both maternal mortality and perinatal mortality are lowest in the caesaean section group. But the improved perinatal salvage in caesarean section babies may partially reflect the tendency to avoid caesarean section in gross prematurity. The ideal anaesthesia for eclampsia remains unknown but the results with use of general anaesthesia in all cases with precautions produced favourable results.