A RANDOMIZED, PROSPECTIVE-STUDY COMPARING ONCE-DAILY GENTAMICIN VERSUS THRICE-DAILY GENTAMICIN IN THE TREATMENT OF PUERPERAL INFECTION

OBJECTIVE: The efficacy, safety, and antibiotic-related charges for on ce-daily gentamicin with twice-daily clindamycin were compared with th ose of thrice-daily dosing of these antibiotics. STUDY DESIGN: Patient s with puerperal endometritis or with chorioamnionitis in labor assess ed to be at risk for endometritis were randomized to receive gentamici n 4 mg/kg intravenously every 24 hours with clindamycin 1200 mg intrav enously every 12 hours (experimental arm) or gentamicin 1.33 mg/kg int ravenously and clindamycin 800 mg intravenously every 8 hours (convent ional 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 confound ing variables. RESULTS: There were 135 and 137 patients randomized to the experimental and conventional interval arms, respectively. Cures w ere obtained in 94.1% and 87.6% of patients in the experimental and co nventional arms, respectively It, = 0.06]. The experimental arm had me an antibiotic charges of $250.79 Versus $442.49 in the conventional an (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 genta micin and clindamycin for peripartum uterine infection. The experiment al regimen results in substantial cost savings. The incidence of nephr otoxicity is low.