TREATMENT OF POST CESAREAN-SECTION ENDOMETRITIS WITH AMPICILLIN AND SULBACTAM OR CLINDAMYCIN AND GENTAMICIN

Seventy-seven patients were prospectively enrolled in a randomized cli nical trial to compare two antimicrobial regimens for the treatment of post-cesarean section endometritis. The two groups were not significa ntly different with respect to age, race, gravidity, parity, hours in labor, cesarean section indication, preoperative or postoperative hemo globin/hematocrit, pretreatment white blood cell count or pretreatment temperature. Pretreatment urine, blood and endometrial cultures were obtained. One or more organisms was recovered from the endometrium in 90% of the patients using a double-lumen sampling device. The most fre quent endometrial isolates were Peptostreptococcus and Bacteroides spe cies, followed by Gardnerella vaginalis and enterococci. Thirty (81%) of 37 patients receiving ampicillin/sulbactam and 33 (83%) of 40 recei ving gentamicin and clindamycin responded to therapy. There were 14 (1 8%) treatment failures, 7 in each group. Five (36%) of the 14 clinical failures were due to septic pelvic thrombophlebitis, 2 (14%) of the 1 4 failures were complications of intraabdominal abscesses, and the rem aining 7 patients responded after a change in their antibiotic regimen . We conclude that ampicillin/sulbactam and clindamycin/gentamicin are similarly effective for the treatment of post-cesarean section endome tritis.