A COMPARISON OF ONCE-DAILY AND 8-HOUR GENTAMICIN DOSING IN THE TREATMENT OF POSTPARTUM ENDOMETRITIS

Objective: To evaluate whether once-daily gentamicin dosing is as effe ctive as the traditional 8-hour regimen for the treatment of postpartu m endometritis. Methods: Postpartum women with endometritis were rando mized to receive gentamicin 5 mg/kg as a single daily dose or 1.75 mg/ kg every 8 hours. All subjects also received clindamycin. Each partici pant had a peak serum gentamicin level of at least 5.0 mu g/mL within the first 24 hours. The dosing regimens were compared by analyzing the number of hours that patients were febrile, the length of hospital st ay occurrence of complications, pharmacy costs, and nursing time requi red to administer the regimens. Results: The study group (n = 62) and the control group (n = 65) were similar in demographic characteristics and the presence of endometritis risk factors. No differences were fo und between the groups in the number of patients who completed therapy without complications, required changes in antibiotics, or required r eadmission for endometritis. The groups did not differ in the number o f hours that patients remained febrile after the start of therapy or i n the length of hospital stay. No patient in the study group had an in itial peak serum concentration less than 5.0 mu g/mL, whereas 24 patie nts in the control group had initial peak serum concentrations less th an 5.0 mu g/mL and required dose adjustment, a statistically significa nt difference (P < .001). Pharmacy costs averaged $16.12 +/- 5.68 for the study group and $41.75 +/- 17.41 for the control group, also a sig nificant difference (P < .001). Nurse tasking time averaged 13.62 +/- 2.56 minutes for the study group and 28.06 +/- 8.77 minutes for the co ntrol group (P < .001). Conclusion: In patients with postpartum endome tritis, once-daily gentamicin dosing provides consistently high peak s erum levels of gentamicin, requires less nurse tasking time, costs les s, and is as effective as the 8-hour dosing regimen.