title: Ceftazidime/clindamycin versus tobramycin/clindamycin in the treatment of intra-abdominal infections.
abstract: In order to assess the efficacy and toxicity of ceftazidime as a substitute for aminoglycosides in the treatment of intra-abdominal sepsis, a prospective randomized trial was conducted. Ninety-four patients (49% trauma) were randomized to receive ceftazidime/clindamycin (CAZ/C) (n = 47) or tobramycin/clindamycin (T/C) (n = 47). CAZ (2.0 gm) and C (0.9 gm) were administered intravenously every 8 hours while T dosage was adjusted to maintain peak (5-8 mg/L) and trough (less than 2 mg/L) concentrations. Age, sex, baseline serum creatinine, and etiology of infection were comparable in the two groups. Clinical cure was similar in culture-positive and culture-negative patients who received CAZ/C (94% vs 88%). The clinical cure rate however was significantly lower in the T/C culture positive (73%) than in the culture negative patients (100%) (P = 0.016). Pathogenic organisms were eradicated in 100% (30/30) and 76% (13/17) of CAZ/C and T/C patients, respectively (P = 0.0006). Nephrotoxicity Nephrotoxicity or ototoxicity was observed in none of the CAZ/C patients and in one and two T/C patients, respectively. CAZ/C more effectively eradicated the bacteria isolated from these patients and no significant difference in clinical response was observed in culture-positive patients. These findings plus the lack of toxicity suggest that CAZ/C is an effective alternative for treatment of IAI.
authors.affiliation: Department of Medicine, Hennepin County Medical Center, Minneapolis, MN 55415.
authors.forename: M P
authors.initials: MP
authors.lastname: Bubrick
authors.forename: K L
authors.initials: KL
authors.lastname: Heim-Duthoy
authors.forename: A E
authors.initials: AE
authors.lastname: Yellin
authors.forename: T V
authors.initials: TV
authors.lastname: Berne
authors.forename: P N
authors.initials: PN
authors.lastname: Heseltine
authors.forename: M D
authors.initials: MD
authors.lastname: Appleman
authors.forename: D M
authors.initials: DM
authors.lastname: Cocchetto
authors.forename: G R
authors.initials: GR
authors.lastname: Matzke
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D001424:Bacterial Infections / Q000188:drug therapy* / Q000601:surgery; D002442:Ceftazidime / Q000627:therapeutic use*; D002981:Clindamycin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D014031:Tobramycin / Q000627:therapeutic use*
chemical_list: D002981:Clindamycin; D002442:Ceftazidime; D014031:Tobramycin