Superiority of aztreonam/clindamycin compared with gentamicin/clindamycin in patients with penetrating abdominal trauma.
There were 73 evaluable patients entered into a prospective, double-blinded trial comparing aztreonam/clindamycin (A/C) to gentamicin/clindamycin (G/C) for the prevention of infection after penetrating abdominal trauma. Aztreonam was administered at a dosage of 2 g every 8 hours and gentamicin at 5 mg/kg for the first 24 hours and then adjusted by serum monitoring to a peak of 6 to 8 micrograms/mL and a trough of less than 2 micrograms/mL; all patients received 900 mg of clindamycin every 8 hours. Patients with colon wounds received 4 days of antibiotics, and the remaining patients received a 24-hour course. Gunshot wounds occurred in 69% of patients: 74% of all patients had some hollow viscus injury, and 26% had only solid viscus injury. The groups were well matched according to abdominal trauma index, percentage with colon injury, and transfusion requirements. Failures occurred in eight patients (11%): two wound infections, five intra-abdominal infections, and one case of necrotizing fasciitis. Seven infections occurred in 36 (19%) G/C patients compared with 1 in 37 (3%) A/C patients (p < 0.03). The hospital stay was 12 +/- 11 days for G/C patients and 8 +/- 7 for A/C patients (p < 0.12). The superiority of the A/C regimen may be partially attributable to relative underdosing of gentamicin (approximately half of the patients had inadequate levels after 24 hours) combined with a favorable pharmacokinetic profile (significantly prolonged half-life) of aztreonam in this clinical setting.
Fabian
T C
TC
Department of Surgery, University of Tennessee, Memphis.
Hess
M M
MM
Croce
M A
MA
Wilson
R S
RS
Wilson
S E
SE
Charland
S L
SL
Rodman
J H
JH
Boucher
B A
BA
D000007:Abdominal Injuries / Q000150:complications*; D000328:Adult; D001398:Aztreonam / Q000493:pharmacokinetics / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D001803:Blood Transfusion; D002981:Clindamycin / Q000627:therapeutic use; D003106:Colon / Q000293:injuries; D004311:Double-Blind Method; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014948:Wounds, Gunshot / Q000150:complications; D014950:Wounds, Penetrating / Q000150:complications*
D005839:Gentamicins; D002981:Clindamycin; D001398:Aztreonam