A comparison of ampicillin plus sulbactam versus clindamycin and gentamicin for treatment of postpartum infection

Abstract

Thirty‐six hospitalized patients, 18 in each of two groups, with postpartum upper genital tract infection were enrolled in a randomized, prospective study comparing treatment with sulbactam/ampicillin, to treatment with clindamycin/gentamicin. One (5.5%) clinical failure was reported in each group. Side effects were minimal in both groups and did not warrant discontinuation of treatment. The in vitro activity of ampicillin versus sulbactam/ampicillin (1: 2) was evaluated and these data were compared with data from other drugs commonly used for aerobic and anaerobic infections. Sulbactam eliminated resistance to ampicillin in all anaerobic and most aerobic isolates.

Rational antibiotic therapy and the position of ampicillin/sulbactam

“…Numerous studies in the late 1980s and early 1990s demonstrated that AMS was an effective therapy for the treatment of post-operative infections, pelvic inflammatory disease and post-Caesarean and post-partum endometritis, with equivalent clinical efficacy to comparator agents (81-95% vs. 83-95%), including metronidazole/gentamicin, cefoxitin, cefoxitin/doxycycline, gentamicin/clindamycin and clindamycin alone [64][65][66][67][68][69][70][71][72].…”

Oral and Intramuscular Treatment Options for Early Postpartum Endometritis in Low-Resource Settings

“…46,59 In phase II, 530 articles were reviewed, of which 38 provided genus or speciated information related to organisms identified by endometrial culture at the time of diagnosis (before antibiotic treatment). We identified 38 studies 17,18,21,22,25,29,30,33,34,36,37,40,42,44,46,48,49,51,55,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] that reported pathogens from endometrial samples of patients with a clinical diagnosis of postpartum endometritis. We then generated a list of the most common 20 genus and family ( Table 2).…”

“…Nevertheless, many intravenous regimens demonstrated high numbers of patients clinically cured (Table 1). When data from all studies were aggregated, multiple single-agent antibiotics reached the 85% clinical cure threshold: amoxicillin-clauvulanate, 17 ampicillinsulbactam, 17,[32][33][34][35][36][37] aztreonam, 20 cefotaxime, 38-40 cefotetan, 32,41-45 ceftazidime, 46 chloramphenicol, 47 clindamycin, 36,47 ertapenem, 48 imipenem-cilastatin, 49 meropenem, 50 mezlocillin, [51][52][53] piperacillin, 54,55 Unauthorized reproduction of this article is prohibited.…”

Optimizing Treatment of Intra-amniotic Infection and Early-Onset Postpartum Endometritis: Advantages of Single-Agent Therapy

“…6,7 In August 2009, DHMC adopted the treatment regimen summarized in Figure 2 for IAI and early-onset PPE for all patients not allergic to penicillin, regardless of delivery method (vaginal vs cesarean) and regardless of time of onset of IAI or PPE. Treatment involves intravenous administration of ampicillin/sulbactam until the patient has been afebrile for 24 hours.…”