@entity581 in XXXX .

@entity1 @entity295 @entity868 @entity5 @entity114 @entity5898 @entity4509 @entity2886 @entity281 @entity581 @entity5280 @entity1320 @entity4028 @entity3402
@entity581 have always had a major role in the treatment of @entity281 . This therapeutic emphasis has been based upon the bactericidal activity of the @entity581 against gram-negative aerobes. This group of organisms is important to the gynecologist because of their frequent isolation from soft tissue, urinary sites, and the bloodstream in @entity1 with nosocomial or community-acquired @entity5280 . In the past decade, there has been increasing clinical awareness of the multi-bacterial nature of these soft tissue @entity5280 . A major therapeutic change directed against gram-negative anaerobes has been the substitution of more effective agents like @entity3402 or @entity868 for the @entity114 arm of the older @entity114 - @entity4028 combination. The majority of @entity1320 treated by gynecologists occur in @entity1 who are younger and usually healthier than those with similar @entity281 who are treated by general surgeons. Consequently, in many instances, single drug therapy with a @entity5898 (usually cefoxitin) is adequate, if combined with surgical drainage when indicated. However, there is an increasingly larger group of @entity1 who are significantly older and who may also have pelvic @entity5 . In addition, they may be immunocompromised. Infections in this group mandate the use of the most effective antimicrobial agents that will cover the broadest spectrum. When anaerobic bacteria are involved, either @entity3402 or @entity868 are acceptable choices; for aerobic gram-negative organisms, an @entity4028 should be used. Recent studies suggest that @entity4509 may be the best choice, since it is associated with a low level of bacterial resistance and has been shown to reduce levels of resistance to other @entity581 . @entity4509 has become the "gold standard" for comparisons with any new @entity2886 or penicillins. New developments will modify the use of @entity581 in the future. The expansion of oncology care with immune-system-modifying chemotherapy and radiation will expose @entity1 to the dangers of gram-negative @entity295 . @entity581 are a logical part of the initial therapeutic regimen for these septic @entity1 . On the other hand, the majority of gynecologic @entity1 with @entity5280 are young and healthy. Recent studies have demonstrated that as many as 40 percent of these @entity1 will be underdosed by standard treatment regimens based upon ideal body weight. This means that @entity1 receiving @entity581 will require monitoring of peak and trough levels to insure therapeutic drug levels.(ABSTRACT TRUNCATED AT 400 WORDS)
