Randomized comparison of ceftazidime versus clindamycin-tobramycin in the treatment of obstetrical and gynecological infections

Abstract

A randomized comparison of ceftazidime versus clindamycin-tobramycin was performed for the treatment of obstetrical and gynecological infections. Entry criteria were an oral temperature of _38°C and a clinical diagnosis of endometritis, salpingitis, or pelvic cellulitis after hysterectomy. All patients with endometritis had cultures of intrauterine material obtained via a transcervical single-lumen catheter. The patients with pelvic cellulitis had material from the vaginal apex aspirated for culture, and all patients with salpingitis had a culdocentesis for culture of intraperitoneal material. Of 38 patients who received ceftazidime, 34 had endometritis after cesarean section, 3 had endometritis after abortion, and 1 had pelvic cellulitis. Of 39 patients who received clindamycin-tobramycin, 35 had endometritis after cesarean section, 3 had salpingitis, and 1 had pelvic cellulitis. The most common bacterial isolates were Lactobacillus sp., Bacteroides bivius, Escherichia coli, other gram-negative aerobic bacilli, group B streptococci, and other aerobic streptococci. Bacteremia occurred in 9.0%o of the patients. Of the patients receiving clindamycin-tobramycin and ceftazidime, 34 (87.2%) and 34 (89.5%), respectively, responded to therapy. All the clinical failures occurred in patients with endometritis after cesarean section. Clinical failures had persistent fever despite 3 or more days of treatment. One of the patients receiving clindamycin-tobramycin developed an urticarial rash after her infection had resolved. No patient in either group developed diarrhea. In these small groups of patients, there were no significant differences in cure rate, side effects, or length of hospital stay.Because of their polymicrobial etiology, obstetrical and gynecological infections require treatment with broad-spectrum antibiotics (2). The combination of clindamycin and an aminoglycoside is often utilized, but the newer cephalosporins are also effective as single-agent therapy (4-6, 12

Role of Bacteroides bivius beta-lactamase in beta-lactam susceptibility

“…Overall, the susceptibility pattern of our isolates were similar to that reported by other groups (1,10,11,18,21). In this study the most active agent in vitro was ceftizoxime, followed by a 2:1 combination of amoxicillin and clavulanic acid.…”

Occurrence of clindamycin-resistant anaerobic bacteria isolated from cultures taken following clindamycin therapy

“…Whereas some investigators have noted the occurrence of clindamycin-resistant anaerobic bacteria in in vitro studies (3, 9, 14, 18, 21), they have not specified the relationship of this occurrence to clindamycin treatment. Others who have presented results of studies in which clindamycin was used to treat obstetric or gynecologic infections have not reported results of posttreatment cultures or the susceptibilities of organisms from these cultures (2,6,23). The purpose of the present study was to review pre-and posttreatment culture results, organism susceptibility to clindamycin, and outcomes of treatment for patients who were enrolled in prospective antibiotic treatment trials for female upper genital tract infection and who were treated with clindamycin.…”

“…In obstetric and gynecologic practice, clindamycin plus an aminoglycoside is a frequent treatment regimen for pelvic soft tissue infections and in studies of safety and efficacy of new antimicrobials is often used as the standard treatment with which newer treatment regimens are compared (2,7,22). In the studies we have done, we have noticed that whereas the clinical outcomes from the clindamycin regimen have been acceptable, a number of clindamycin-resistant anaerobic bacteria, especially anaerobic gram-positive cocci, were isolated from posttreatment cultures.…”

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

“…16,[56][57][58] Among the combined antibiotic regimens that achieved high rates of cure, 46,59 eight contained an aminoglycoside-either gentamicin or tobramycin-as part of the regimen 46,59 and five of these included clindamycin. 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.…”

“…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.…”