Bacteriological epidemiology and treatment of bacterial vaginosis

One hundred symptomatic women with clinical bacterial vaginosis (BV) were enrolled in this study. The bacteriological epidemiology of BV and efficacy of oral or vaginal administration of antimicrobial agents for treatment of BV were investigated. The epidemiology of BV was investigated before antimicrobial therapy. Fifty patients were treated with oral administration of metronidazole (MTN), 500 mg twice a day, and 50 patients with 2% clindamycin (CLDM) phosphate in a vaginal cream, 5 g once a day for 7 days. The major organisms occurring were Streptococcus agalactiae, Escherichia coli, Gardnerella vaginalis, Peptostreptococcus species, Bacteroides species, Prevotella species, and Mobiluncus species and opportunistic pathogens such as Staphylococcus epidermidis and Enterococcus faecalis. The therapeutic efficacy of CLDM cream on BV appeared to be preferable to oral MTN from clinical and bacteriological aspects. The clinical and bacteriological effectiveness of MTN and CLDM in the treatment of BV suggests that anaerobes might play a major role in causing the clinical symptoms in patients with BV.

Study on treatment of bacterial vaginosis with oral administration of metronidazole or cefdinir

Bacterial vaginosis (BV) is considered to be one of the most common vaginal infections in women. Fifteen symptomatic women with BV were enrolled in this study. Ten patients with the diagnosis of BV were treated with 10 days oral administration of metronidazole (MTN), 500 mg twice a day, and five patients with cefdinir (CFDN), 300 mg three times a day. In the MTN therapy, the rate of abnormal vaginal discharge subjectively decreased from 100 to 60%, the rate of abnormal vaginal discharges objectively decreased from 100 to 20%, the rate of positive amine tests decreased from 100 to 20%, the rate of genital malodor and abnormal pH of vaginal discharges decreased substantially from 100 to 10%, and the rate of the presence of clue cells also decreased notably from 90 to 10%. However, in the CFDN therapy, none of these factors improved. With respect to susceptibility to CFDN and MTN, CFDN demonstrated good antibacterial activity against almost all bacteria isolated except Gardnerella vaginalis. On the other hand, MTN demonstrated excellent activity against anaerobic bacteria except Peptostreptococcus spp., and had no antibacterial activity against aerobic bacteria. Since the therapeutic effect of MTN in BV appeared to be better than that of CFDN, anaerobes may play a major role in causing clinical symptoms in patients with BV.

In vitro antibacterial activity of FK037, a new parenteral broad-spectrum cephalosporin, against recent clinical isolates in the fields of obstetrics and gynecology

The antibacterial activity of a new parenteral cephalosporin, FK037 was assessed against recent aerobic and anaerobic strains isolated from patients in the fields of obstetrics and gynecology during the period between January 1992 and June 1993. The MICs of FK037 for 90% of the clinical isolates tested were 0.10 microgram/ml for Escherichia coli and Klebsiella pneumoniae, 0.20 microgram/ml for Streptococcus agalactiae, 0.39 microgram/ml for Gardnerella vaginalis, 0.78 microgram/ml for Staphylococcus epidermidis, Peptostreptococcus anaerobius and Mobiluncus spp., 1.56 micrograms/ml for Peptostreptococcus magnus, 3.13 micrograms/ml for methicillin-sensitive Staphylococcus aureus, 25 micrograms/ml for methicillin-resistant S. aureus (MRSA), Bacteroides fragilis and Prevotella disiens, 100 micrograms/ml for Bacteroides thetaiotaomicron and Prevotella bivia; and > 100 micrograms/ml for Enterococcus faecalis. FK037 was superior in potency to ceftazidime against all strains except E. faecalis, P. anaerobius and P. bivia. It was 4- to 16-fold more active than cefotaxime against aerobic gram-positive bacteria and P. disiens, and its activity was similar to that of cefotaxime against the other strains. FK037 had 4- to 16-fold stronger activity than flomoxef against MRSA, S. agalactiae and E. coli and a similar activity to flomoxef against the other strains except G. vaginalis and B. fragilis that were 4-fold more sensitive to flomoxef than to FK037.

Internal bacterial flora of solid uterine cervical cancer

Twenty-five patients with uterine cervical cancer (Two cases stage O; four cases stage Ia; five cases stage Ib; one case stage IIa; ten cases stage IIb; two cases stage IIIa; one case stage IVa) served as the subjects. The bacterial flora inside the cervical cancers was investigated using the optimal technique. There was mixed abnormal aerobic and anaerobic bacterial flora in all subjects. The average number of bacterial species isolated from inside the cervical cancers was 6.3. The predominant bacteria isolated were the aerobes, Staphylococcus haemolyticus, Streptococcus agalactiae, Escherichia coli and Gardnerella vaginalis, and Prevotella bivia. As the stages of cervical cancer progressed, G. vaginalis, B. distasonis and P. bivia were detected at higher rates and higher counts than other bacteria. These findings suggest that there is a relationship between G. vaginalis, B. distasonis and P. bivia and the onset and growth of cervical cancer.

Endometrial bacterial flora detected in patients with uterine endometrial cancer

Certain bacteria produce some carcinogens such as N-nitro compounds, n-butyric acid and n-valeric acid. From this point of view, the examination of intrauterine bacterial flora in patients with uterine endometrial cancer may provide important information. Twenty patients with the diagnosis of uterine endometrial cancer and 20 patients without complications other than myoma uteri were enrolled in the study. Enterobacteriaceae, Streptococcus agalactiae and anaerobic bacteria were mainly detected. The products of these bacteria might be considered to contribute to the initiation of endometrial carcinogenesis. Mixed abnormal flora between aerobic and anaerobic bacteria were detected in all patients with uterine endometrial cancer. It is suggested that uterine endometrial cancer provides favorable conditions for bacterial growth. Mixed abnormal bacterial flora also might influence the onset and growth of uterine endometrial cancer.

Bacterial flora detected of the uterine endometrial cavity of diabetic patients with myoma uteri

Patients with diabetes frequently suffer from various postoperative complications, especially infection. Diabetic patients also have a high incidence of uterine endometrial cancer. The nature of the intrauterine bacterial flora may be related to both infection and carcinogenesis. Therefore, identification of the intrauterine bacterial flora in diabetic patients may be useful. Bacteria were detected in the uterine endometrial cavity of 100% of ten diabetic patients with myoma uteri. However, among 20 non-diabetic control patients with myoma uteri, only three 15% harbored bacteria. Members of the Enterobacteriaceae (Escherichia coli, Proteus spp., Enterobacter cloacae, and Klebsiella pneumoniae) were the predominant bacteria. We speculate that bacterial products contribute to carcinogenesis, as has been proposed for colon carcinoma. Antimicrobial agents active against Enterobacteriaceae should be used to prevent postoperative infections in gynecologic procedures in diabetic patients.

Bacterial flora detected in the uterine endometrial cavity of normal puerperae on the puerperal first day and on the puerperal fifth day after incidental use of cefpodoxime proxetil

In Japan, oral antimicrobial agents are prophylactically used with oxytocics after normal delivery to prevent puerperal infections. The present study was designed to investigate bacterial floras in the endometrial cavity immediately after normal delivery and the effect of prophylactic use of anti-microbial agents on those floras. Sixty-six puerperae who underwent uneventful courses of pregnancy and delivery were subjected for this study. Intrauterine contents were collected on the first day and the fifth day of the puerperium and submitted to microbiological examinations. Cefpodoxime proxetil (CPDX-PR) was orally given to the puerperae for prophylaxis for 5 days after the initial sampling. On the puerperal first day, a total of 98 strains (71 strains of aerobic bacteria, 27 strains of anaerobic bacteria) was detected in the uteri of the 66 subjects. The incidences of aerobic Gram-positive cocci, aerobic Gram-negative bacilli and anaerobic bacteria were 59.2%, 12.2%, 27.6% of the 98 strains, respectively. On the puerperal fifth day, a total of 82 strains (51 strains of aerobic bacteria and 31 strains of anaerobic bacteria) were detected in the uteri of the 66 subjects. The incidences of aerobic Gram-positive cocci, aerobic Gram-negative bacilli and anaerobic bacteria were 52.5%, 8.6% and 37.7% of 82 strains, respectively.

[Incidence of Mobiluncus spp. from the patients with clinical bacterial vaginosis]

Aerobic and anaerobic cultures as well as a Gram stain and wet mount preparations were made of vaginal swabs in twenty patients with clinical bacterial vaginosis. Mobiluncus spp. were detected in 7 cases (35%). Cultures appeared to indicate that mixed abnormal flora between aerobic and anaerobic bacteria are found in bacterial vaginosis, and that Mobiluncus spp. may play a role in bacterial vaginosis.

[Pharmacokinetic and clinical studies on flomoxef in perinatal period]

Pharmacokinetic and clinical studies on flomoxef (FMOX) in the perinatal period were carried out. The results are summarized as follows. 1. The concentration of FMOX in umbilical cord serum was about 10 micrograms/ml in about 30 minutes after 1 g one shot intravenous injection. Amniotic fluid concentration was 7 micrograms/ml in 41 minutes after administration. By 1 hour intravenous drip infusion, FMOX concentration in umbilical cord serum was about 5 micrograms/ml in 2-3 hours after administration. Amniotic fluid concentration of about 20 micrograms/ml was found in 1 case. 2. FMOX 1-2 g x 2-3/day was given by intravenous drip infusion to 7 cases of perinatal infection for 4-26 days. Clinical efficacies were evaluated a good for all cases. Neither side effect nor abnormal laboratory test value was observed. Consequently, FMOX was considered to be highly effective and safe for its clinical use in perinatal period infections.