A double-blind, randomized comparison of clindamycin-gentamicin versus cefamandole for treatment of post-cesarean section endomyometritis.
Among patients with endomyometritis after cesarean section, a double-blind comparison of clindamycin-gentamicin versus cefamandole-placebo therapy was performed. Study criteria were: exclusion--use of prophylactic antibiotics or allergy to the drugs used; entry--uterine tenderness, oral temperature greater than or equal to 101 degrees F, and leukocytosis. Uterine specimens for culture were obtained via a single-lumen transcervical catheter. Most common isolates were Bacteroides bivius, Escherichia coli, and anaerobic cocci. Bacteremia occurred in 9.0%. Therapy results were: [Chart: see text]. Therapeutic failures were defined as persistent fever despite 3 or more days of treatment. Among the six clindamycin-gentamicin therapeutic failures, one patient had a resistant organism, and one had a pelvic mass. Among the 13 cefamandole-placebo therapeutic failures, three patients had resistant organisms, and one had a pelvic mass. Cause of persistent fever was not evident in the other patients. Side effects that necessitated discontinuation of therapy were: clindamycin-gentamicin group--diarrhea (six), allergic response (one); cefamandole-placebo group--diarrhea (two), allergic response (one). If the common practice of excluding side-effect failures is followed, there were more cures in the clindamycin-gentamicin group (P = 0.06).
D000328:Adult; D002435:Cefamandole / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D002585:Cesarean Section; D002981:Clindamycin / Q000008:administration & dosage*; D004311:Double-Blind Method; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D004716:Endometritis / Q000188:drug therapy*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage*; D006801:Humans; D011247:Pregnancy; D011897:Random Allocation; D013530:Surgical Wound Infection / Q000188:drug therapy*
D002511:Cephalosporins; D005839:Gentamicins; D002981:Clindamycin; D002435:Cefamandole