A randomized, prospective study comparing once-daily gentamicin versus thrice-daily gentamicin in the treatment of puerperal infection☆,☆☆,★
Section snippets
Material and methods
This experimental study was approved by the Institutional Review Board at Carolinas Medical Center in Charlotte, North Carolina. Patients on the resident obstetric service were enrolled in the study from July 1, 1994, to July 31, 1996, if they signed an informed consent form and met one of the following criteria: (1) two temperatures ≥100.4° F 6 hours apart excluding the first 12 postpartum hours, (2) a single temperature ≥102° F in first 12 postpartum hours, (3) a diagnosis of chorioamnionitis
Results
Two hundred ninety-nine patients were enrolled in the study. Twenty-seven were excluded for protocol violations: 9 did not meet enrollment criteria, 7 had inappropriate antibiotic changes before receiving 72 hours of the assigned treatment regimen, 8 patients never received study medications, and 3 patients had antibiotics discontinued before cure was achieved. This left 272 patients available for analysis. One hundred thirty-seven patients were randomized to the conventional arm and 135
Comment
Aminoglycosides are commonly used to treat upper genital tract infection because they provide reliable broad-spectrum bactericidal coverage against facultative aerobic gram-negative bacilli. Bacterial resistance to aminoglycosides is not common, and gentamicin is inexpensive because patent protection rights have expired. Nonetheless, some physicians are reluctant to use aminoglycosides because of the potential renal and ototoxicity. Many physicians who do use aminoglycosides feel compelled to
References (20)
- et al.
Once versus thrice daily gentamicin in patients with serious infections
Lancet
(1993) - et al.
A comparison of once-daily and 8-hour gentamicin dosing in the treatment of postpartum endometritis
Obstet Gynecol
(1996) - et al.
Single daily dose therapy with aminoglycosides
J Hosp Infect
(1991) - et al.
Delayed gentamicin elimination in patients with severe preeclampsia
Am J Obstet Gynecol
(1985) - et al.
Does administration of an aminoglycoside in a single daily dose affect its efficacy and toxicity?
J Antimicrob Chemother
(1990) - et al.
Aminoglycosides: single or multiple daily dosing? a meta-analysis on efficacy and safety
Eur J Clin Pharmacol
(1995) Netilmicin in the treatment of gram-negative bacteremia: single daily versus multiple daily dosage
J Infect Dis
(1989)- et al.
A multicentric study of netilmicin once daily versus thrice daily in patients with appendicitis and other intra-abdominal infections
Antimicrob Agents Chemother
(1989) Once-daily aminoglycoside therapy
Antimicrob Agents Chemother
(1991)- et al.
Pharmacokinetics and safety of antimicrobial agents during pregnancy
Rev Infect Dis
(1985)
Cited by (41)
Management of clinical chorioamnionitis: an evidence-based approach
2020, American Journal of Obstetrics and GynecologyCitation Excerpt :Therefore, the antibiotic regimens that have been assessed in randomized controlled trials predate the modern understanding of the microbiology of the amniotic cavity in clinical chorioamnionitis and intraamniotic infection.45–53,58,59,62 We identified 14 randomized controlled trials98–111 (Table 1) and 1 systematic review and meta-analysis112 that assessed the use of antibiotics in women with clinical chorioamnionitis. Most trials included patients with a gestational age of ≥34 weeks and in labor.
Update on new medicinal applications of gentamicin: Evidence-based review
2014, Journal of the Formosan Medical AssociationCitation Excerpt :Lyell and colleagues11 concluded that daily GM appeared to be as effective as 8-hour GM for the treatment of intrapartum chorioamnionitis, without differences in maternal or neonatal morbidities. Mitra et al12 reported that cure rates of combination therapy with once-daily GM ranged from 88% to 94% in peripartum infection of the uterus and postnatal infection. Phacoemulsification with intraocular lens implantation is currently the most common ophthalmic surgical procedure, and endophthalmitis continues to be a sight-threatening complication of cataract surgery, despite advances in surgical techniques.13
Evidence for the clinical management of chorioamnionitis
2012, Seminars in Fetal and Neonatal MedicineAdverse Drug Reactions and Drug-drug Interactions
2011, Pediatric Critical Care: Expert Consult Premium EditionAdverse Drug Reactions and Drug-drug Interactions
2011, Pediatric Critical CarePostpartum Biomedical Concerns: Breastfeeding
2008, Family Medicine Obstetrics
- ☆
From the Departments of Obstetrics and Gynecology and Research Planning and Evaluation, Carolinas Medical Center.
- ☆☆
Reprints not available from the authors.
- ★
0002-9378/97 $5.00 + 0 6/6/84110