Gentamicin and clindamycin therapy in postpartum endometritis: the efficacy of daily dosing versus dosing every 8 hours.
OBJECTIVE
The objective of the study was to evaluate the efficacy of gentamicin and clindamycin given once daily versus the more common 8-hour dosing regimen for the treatment of postpartum endometritis.


METHODS
In a prospective, placebo-controlled, double-blinded study, patients who had postpartum endometritis diagnosed were randomly selected to receive 1.5 mg/kg gentamicin and 900 mg clindamycin phosphate administered every 8 hours versus gentamicin 5 mg/kg and clindamycin phosphate 2700 mg administered as a single-daily dose. The single-dose group received an infusion of gentamicin and clindamycin, followed by an administration of intravenous placebo 8 and 16 hours later to maintain blinding. Treatment success was defined as absence of fever 72 hours after initiation of antibiotic therapy.


RESULTS
One hundred ten patients were enrolled. The daily-dose group (n = 55) and the thrice-daily dose group (n = 55) were similar with respect to age, gravidity, parity, gestational age, and maternal weight. Clinical characteristics (including maximum temperature, presence of predelivery chorioamnionitis, white blood cell count, and mode of delivery) were also similar. There was no difference in the mean time from initiation of therapy until becoming afebrile in the daily-dose group (27.4 +/- 24.9 hours) compared with the thrice-daily dose group (32.9 +/- 26.3 hours). Forty-five of 56 (82%) patients in the daily-dose group and 38 of 55 (69%) patients in the thrice-daily dose group had treatment success (P =.12).


CONCLUSIONS
Once-daily dosing with gentamicin and clindamycin in women with postpartum endometritis has a similar success rate as the standard every 8-hour dosing schedule.
Livingston
Jeffrey C
JC
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA. jlivingston@carilion.com
Llata
Eloisa
E
Rinehart
Eliza
E
Leidwanger
Colleen
C
Mabie
Bill
B
Haddad
Bassam
B
Sibai
Baha
B
D000293:Adolescent; D000328:Adult; D001835:Body Weight; D002821:Chorioamnionitis; D002981:Clindamycin / Q000008:administration & dosage*; D004311:Double-Blind Method; D004716:Endometritis / Q000188:drug therapy*; D005260:Female; D005334:Fever; D005839:Gentamicins / Q000008:administration & dosage*; D005865:Gestational Age; D006801:Humans; D007958:Leukocyte Count; D010298:Parity; D010919:Placebos; D011247:Pregnancy; D011446:Prospective Studies; D011644:Puerperal Disorders / Q000188:drug therapy*; D016896:Treatment Outcome
D005839:Gentamicins; D010919:Placebos; D002981:Clindamycin