Treatment of post-cesarean section endometritis with ampicillin and sulbactam or clindamycin and gentamicin.
Seventy-seven patients were prospectively enrolled in a randomized clinical trial to compare two antimicrobial regimens for the treatment of post-cesarean section endometritis. The two groups were not significantly different with respect to age, race, gravidity, parity, hours in labor, cesarean section indication, preoperative or postoperative hemoglobin/hematocrit, pretreatment white blood cell count or pretreatment temperature. Pretreatment urine, blood and endometrial cultures were obtained. One or more organisms was recovered from the endometrium in 90% of the patients using a double-lumen sampling device. The most frequent endometrial isolates were Peptostreptococcus and Bacteroides species, followed by Gardnerella vaginalis and enterococci. Thirty (81%) of 37 patients receiving ampicillin/sulbactam and 33 (83%) of 40 receiving gentamicin and clindamycin responded to therapy. There were 14 (18%) treatment failures, 7 in each group. Five (36%) of the 14 clinical failures were due to septic pelvic thrombophlebitis, 2 (14%) of the 14 failures were complications of intraabdominal abscesses, and the remaining 7 patients responded after a change in their antibiotic regimen. We conclude that ampicillin/sulbactam and clindamycin/gentamicin are similarly effective for the treatment of post-cesarean section endometritis.
Stovall
T G
TG
Department of Obstetrics and Gynecology, University of Tennessee, Memphis.
Thorpe
E M
EM
Ling
F W
FW
D000293:Adolescent; D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D001419:Bacteria / Q000302:isolation & purification; D002585:Cesarean Section; D002981:Clindamycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D004716:Endometritis / Q000188:drug therapy* / Q000382:microbiology; D004717:Endometrium / Q000382:microbiology; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D011183:Postoperative Complications / Q000188:drug therapy*; D011247:Pregnancy; D011446:Prospective Studies; D011645:Puerperal Infection / Q000188:drug therapy*; D013407:Sulbactam / Q000627:therapeutic use
D005839:Gentamicins; D002981:Clindamycin; D000667:Ampicillin; D013407:Sulbactam