A randomized comparison of
ceftazidime versus
clindamycin-
tobramycin was performed for the treatment of obstetrical and gynecological
infections. Entry criteria were an oral temperature of greater than or equal to 38 degrees C and a clinical diagnosis of
endometritis,
salpingitis, or
pelvic cellulitis after
hysterectomy. All patients with
endometritis had cultures of intrauterine material obtained via a transcervical single-lumen
catheter. The patients with
pelvic cellulitis had material from the vaginal apex aspirated for culture, and all patients with
salpingitis had a culdocentesis for culture of intraperitoneal material. Of 38 patients who received
ceftazidime, 34 had
endometritis after
cesarean section, 3 had
endometritis after abortion, and 1 had
pelvic cellulitis. Of 39 patients who received
clindamycin-
tobramycin, 35 had
endometritis after
cesarean section, 3 had
salpingitis, and 1 had
pelvic cellulitis. The most common bacterial isolates were Lactobacillus sp., Bacteroides bivius, Escherichia coli, other gram-negative aerobic bacilli, group B streptococci, and other aerobic streptococci.
Bacteremia occurred in 9.0% of the patients. Of the patients receiving
clindamycin-
tobramycin and
ceftazidime, 34 (87.2%) and 34 (89.5%), respectively, responded to
therapy. All the clinical failures occurred in patients with
endometritis after
cesarean section. Clinical failures had persistent
fever despite 3 or more days of treatment. One of the patients receiving
clindamycin-
tobramycin developed an urticarial
rash after her
infection had resolved. No patient in either group developed
diarrhea. In these small groups of patients, there were no significant differences in cure rate, side effects, or length of
hospital stay.