INFECTION AFTER HYSTERECTOMY tive against the gram-negative aerobic bacteria. Gentamicin appears to be as effective as .other aminoglycosides in the treatment of women with posthysterectomy pelvic infection, and is the least expensive. Although gentamicin was historically adminis- tered parenterally every 8 h, recent data indicate that either 5 or 7 mg/kg once daily is as effective, less expensive, and even less toxic than gentamicin administered 3 times daily7-9 to patients with nor- mal renal function. Peak and trough testing is un- necessary with once daily dosing. If there is no penicillin allergy, ampicillin 2 g every 6 h to cover gram-positive aerobic bacteria should be added to the metronidazole/gentamicin regimen, but may not be necessary for women treated with clindamy- cin and gentamicin. Vancomycin at a dose of 500 mg every 6 h should be given to women.with a type hypersensitivity reaction to penicillin in place of ampicillin. Newer quinolone antibiotics currently undergoing phase III clinical trials have an excep- tionally broad spectrum of activity, and will be available in parenteral and oral preparations. During treatment for infection, the patient should be monitored at least twice daily to insure success and to detect any adverse reaction which might develop. Almost all superficial incisional in- fections respond to opening and draining the area with local wound care 3 times daily consisting of irrigation and debriding with solutions such as hy- drogen peroxide or acetic acid followed by normal saline. Fine mesh gauze applied directly to the in- cisional margins and medial packing with 4 x 4s, or other sterile packing speeds granulation tissue de- velopment. Antibiotic therapy is not usually neces- sary. These wounds may be closed or allowed to heal by secondary intention. Antibiotic treatment failures are uncommon. They may result from 1) development of resistant species; 2) superinfection by different species in 56 INFEC770US DISEASES IN OBSTETRICS AND GYNECOLOGY HEMSELL the infection site; 3) lack of coverage for the patho- gen by the empiric regimen; or 4) volume of infec- tion. Adding to or changing the empiric antibiotic regimen to expand predictable coverage will be successful. In patients with an infected hematoma or abscess, draining will usually facilitate cure. The patient also may have a non-operative site infec- tion, and drug fever must be remembered. REFERENCES 1. Richards WR: An evaluation of the local use of sulfon- amide drugs in certain gynecological operations. Am J Obstet Gynecol 46:541-545, 1944. 2. Turner SJ: The effect of penicillin vaginal suppositories on morbidity in vaginal hysterectomy and on the vaginal flora. Am J Obstet Gynecol 60:806-812, 1950. 3. Soper DE, Bump RC, Hurt WG: Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. Am J Obstet Gynecol 163:1016-1023, 1990. 4. Larson P-G, Platz-Christensen J-J, Forsum U, Pahlson C: Clue cells in predicting infections after abdominal hysterectomy. Obstet Gynecol 77:450-452, 1991. 5. Horan TC, Gaynes WP, Martone WJ, Jarvis WR, Emori TG: CDC definitions of nosocomial surgical site infec- tions, 1992: A modification of CDC definitions of sur- gical wound infections. Infect Control Hosp Epidemiol 13:606-608, 1992. 6. Hager WD, Pascuzzi M, Vernon M: Efficacy of oral an- tibiotics following parenteral antibiotics for serious in- fections in obstetrics and gynecology. Obstet Gynecol 73:326-329, 1989. 7. Tulkens PM, Clerckx-Braun F, Donnez J, et al.: Safety and efficacy of aminoglycosides once-a-day: Experi- mental data and randomized, controlled evaluation in patients suffering from pelvic inflammatory disease. J Drug Dev Suppl 3:71-82, 1988. 8. Belliveau PP, Nicolau DP, Nightingale CH, Quintiliani R: Once-daily gentamicin: Experience in one hundred eighteen patients with postpartum endometritis. J In- fect Dis 1:11-18, 1995. 9. del Priore G, Jackson-Stone M, Shim EK, Garfinkel J, Eighmann MA, Frederiksen MC: A comparison of once- daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis. Obstet Gynecol 87:994-1000, 1996.