Ag. Mitra et al., A RANDOMIZED, PROSPECTIVE-STUDY COMPARING ONCE-DAILY GENTAMICIN VERSUS THRICE-DAILY GENTAMICIN IN THE TREATMENT OF PUERPERAL INFECTION, American journal of obstetrics and gynecology, 177(4), 1997, pp. 786-792
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.