A randomized, prospective study comparing once-daily gentamicin versus thrice-daily gentamicin in the treatment of puerperal infection.

Abstract

OBJECTIVE:

The efficacy, safety, and antibiotic-related charges for once-daily gentamicin with twice-daily clindamycin were compared with those of thrice-daily dosing of these antibiotics.

STUDY DESIGN:

Patients with puerperal endometritis or with chorioamnionitis in labor assessed to be at risk for endometritis were randomized to receive gentamicin 4 mg/kg intravenously every 24 hours with clindamycin 1200 mg intravenously every 12 hours (experimental arm) or gentamicin 1.33 mg/kg intravenously and clindamycin 800 mg intravenously every 8 hours (conventional dosing interval arm). Primary outcomes included cure rates, mean length of treatment, antibiotic-related charges, and nephrotoxicity. Multiple logistic regression analysis was used to control for confounding variables.

RESULTS:

There were 135 and 137 patients randomized to the experimental and conventional interval arms, respectively. Cures were obtained in 94.1% and 87.6% of patients in the experimental and conventional arms, respectively (p = 0.06). The experimental arm had mean antibiotic charges of $250.79 versus $442.49 in the conventional arm (p < 0.0001). There was no permanent nephrotoxicity in either group.

CONCLUSIONS:

Once-daily gentamicin dosing with twice-daily clindamycin dosing is as efficacious and safe as the thrice-daily dosing of gentamicin and clindamycin for peripartum uterine infection. The experimental regimen results in substantial cost savings. The incidence of nephrotoxicity is low.

• Authors: A G Mitra, M K Whitten, S L Laurent, W E Anderson
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 177 Issue 4 Pg. 786-92 (Oct 1997) ISSN: 0002-9378 [Print] United States
• PMID: 9369820 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Anti-Bacterial Agents
• Gentamicins
• Clindamycin

Topics

• Adult
• Anti-Bacterial Agents (administration & dosage, therapeutic use)
• Chorioamnionitis (drug therapy)
• Clindamycin (administration & dosage, therapeutic use)
• Delivery, Obstetric
• Endometritis (drug therapy)
• Female
• Gentamicins (administration & dosage, blood, therapeutic use)
• Humans
• Labor, Obstetric
• Logistic Models
• Pregnancy
• Prospective Studies
• Puerperal Infection (drug therapy)