Moxalactam vs tobramycin-clindamycin. A randomized trial in secondary peritonitis.
One hundred five patients with peritonitis were randomized to receive either tobramycin sulfate plus clindamycin phosphate or moxalactam alone before surgical intervention. Fifty-nine patients were evaluable. A mean of 3.1 (moxalactam) and 3.5 (tobramycin-clindamycin) pathogens per patient were identified. Overall success rate was 85% (tobramycin-clindamycin, 24/30; moxalactam, 26/29). When patients with appendicitis were excluded, there was an observed but not statistically significant advantage of moxalactam over tobramycin-clindamycin (85% vs 67%). There were five deaths (tobramycin-clindamycin, four; moxalactam, one). Other complications included hypoprothrombinemia (tobramycin-clindamycin, five; moxalactam, five), renal dysfunction (tobramycin-clindamycin, three; moxalactam, one), and superinfection (tobramycin-clindamycin, nine; moxalactam, six). More wound infections were noted in the group given tobramycin-clindamycin. These data suggest that moxalactam is as safe and efficacious as tobramycin plus clindamycin. The observed benefits of this agent warrant study in a larger sample to verify advantages of moxalactam over combination therapy.
Stellato
T A
TA
Department of Surgery, University Hospitals of Cleveland, OH 44106.
Danziger
L H
LH
Hau
T
T
Gauderer
M W
MW
Ferron
J L
JL
Gordon
N
N
D000038:Abscess / Q000188:drug therapy / Q000601:surgery; D000293:Adolescent; D000328:Adult; D001442:Bacteroides Infections / Q000188:drug therapy; D002981:Clindamycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D004927:Escherichia coli Infections / Q000209:etiology; D006801:Humans; D007020:Hypoprothrombinemias / Q000139:chemically induced; D007231:Infant, Newborn; D008875:Middle Aged; D009070:Moxalactam / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D010538:Peritonitis / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D011292:Premedication; D011446:Prospective Studies; D011897:Random Allocation; D018805:Sepsis / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy; D013530:Surgical Wound Infection / Q000209:etiology; D014031:Tobramycin / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*
D002981:Clindamycin; D009070:Moxalactam; D014031:Tobramycin