Daily dose of clindamycin versus standard divided doses in obstetrical and gynecological infections: a retrospective cohort study

Abstract

To compare the rates of cure of septic abortion and pelvic inflammatory disease using a daily dose of clindamycin with gentamicin versus divided doses, we conducted a retrospective cohort study, where the electronic records of 661 patients who used clindamycin 1 × , 3 × or 4 ×/day (groups 1, 3 and 4, respectively) between September 2002 and August 2010 were analysed. Major outcomes included rates of cure and failure according to the clinical records. Secondary endpoints were percentage of adverse effects related to medication regimen and the prevalence of positive VDRL and HIV. Similar conditions were observed in all groups − septic abortion: 167/116/123; pelvic inflammatory disease: 73/95/87 (groups 1, 3 and 4, respectively). No significant difference was found among groups for age or for rate of cure. Rates of cure (cure/total [rate (95%CI)]) in groups 1, 3 and 4 were 236/240 [0.983 (0.957−0.993)], 205/211 [0.971 (0.939−0.986)], 203/210 [0.966 (0.932−0.983)], respectively. Days of use of clindamycin was significantly reduced in group 1, compared to groups 3 and 4 (2.6 ± 1.3 vs. 3.5 ± 2.5 vs. 3.3 ± 1.9−mean ± SD; p < 0.0001 – ANOVA), but this may be due to differences in how length of therapy was measured and not the effect on clinical cure.

Keywords

Septic abortion pelvic inflammatory disease PID clindamycin gentamicin sexually transmitted infection treatment dose antibiotics

Get full access to this article

View all access options for this article.

References

Grimes

. Unsafe abortion: the silent scourge. Br Med Bull 2003; 67: 99–113.

Schorge

Schaffer

Pietz

Gynecologic infection. In: Schorge

Schaffer

Halvorson

Hoffman

Bradshaw

Cunningham

(eds). Williams gynecology, 1st ed. New York: McGraw-Hill, 2011.

Workowski

Berman

. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep 2010; 59: 1–110.

MacDougall

Chambers

. Protein synthesis inhibitors and miscellaneous antibacterial agents. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12th ed. New York: McGraw-Hill, 2011.

Leelarasamee

Tatong

Kasattut

. Bioequivalence study of clindamycin phosphate injection (Clinott-P) in Thai healthy volunteers. J Med Assoc Thai 2006; 89: 683–689.

Muller

Mouton

Oostvogel

. Pharmacokinetics of clindamycin in pregnant women in the peripartum period. Antimicrob Agents Chemother 2010; 54: 2175–2181.

Saridomichelakis

Athanasiou

Salame

. Serum pharmacokinetics of clindamycin hydrochloride in normal dogs when administered at two dosage regimens. Vet Dermatol 2011; 22: 429–435.

Flaherty

Rodondi

Guglielmo

. Comparative pharmacokinetics and serum inhibitory activity of clindamycin in different dosing regimens. Antimicrob Agents Chemother 1988; 32: 1825–1859.

U.S. Food and Drug Administration. Cleocin hydrochloride safety data, www.accessdata.fda.gov/drugsatfda_docs/label/2009/050162s085lbl.pdf%5D.pdf (November 2011, accessed 11 November 2011).

10.

Livingston

Llata

Rinehart

. Gentamicin and clindamycin therapy in postpartum endometritis: the efficacy of daily dosing versus dosing every 8 hours. Am J Obstet Gynecol 2003; 188: 149–152.

11.

Moberg

Gottlieb

Nord

. Anaerobic bacteria in uterine infection following first trimester abortion. Eur J Clin Microbiol 1982; 1: 82–86.

12.

Soper

. Postpartum endometritis. Pathophysiology and prevention. J Reprod Med 1988; 33: 97–100.

13.

Ward

Theiler

. Once-daily dosing of gentamicin in obstetrics and gynecology. Clin Obstet Gynecol 2008; 51: 498–506.

14.

World Health Organization. Reproductive health. Managing complications in pregnancy and childbirth: a guide for midwives and doctors, World Health Organization, 2000.

15.

Savaris

de Moraes

Cristovam

. Are antibiotics necessary after 48 hours of improvement in infected/septic abortions? A randomized controlled trial followed by a cohort study. Am J Obstet Gynecol 2011; 204: 301.e1–301.e5.

16.

Lurie

Rahamim

Piper

. Total and differential leukocyte counts percentiles in normal pregnancy. Eur J Obstet Gynecol Reprod Biol 2008; 136: 16–19.

17.

Francois

Bertrand

Beden

. [Early readmission as an indicator of hospital quality of care]. Rev Epidemiol Sante Publique 2001; 49: 183–192.

18.

Sweet

. Treatment of acute pelvic inflammatory disease. Infect Dis Obstet Gynecol 2011; 2011: 561909–561909.

19.

Gunning

. A comparison of piperacillin and clindamycin plus gentamicin in women with pelvic infections. Surg Gynecol Obstet 1986; 163: 156–162.

20.

Hemsell

Martens

Faro

. A multicenter study comparing intravenous meropenem with clindamycin plus gentamicin for the treatment of acute gynecologic and obstetric pelvic infections in hospitalized women. Clin Infect Dis 1997; 24: S222–S230.

21.

Hemsell

Solomkin

Sweet

. Evaluation of new anti-infective drugs for the treatment of acute pelvic infections in hospitalized women. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis 1992; 15: S43–S52.

22.

French

Smaill

. Antibiotic regimens for endometritis after delivery. Cochrane Database Syst Rev 2004, pp. CD001067–CD001067.

23.

Adu-Sarkodie

Brook

Clark

. The potential effect on Neisseria gonorrhoeae of the use of clindamycin vaginal cream in the empirical treatment of vaginal discharge. J Antimicrob Chemother 1995; 36: 557–560.

24.

Balbi

Piscitelli

Di Grazia

. [Acute pelvic inflammatory disease: comparison of therapeutic protocols]. Minerva Ginecol 1996; 48: 19–23.

25.

Brocklehurst

Rooney

. Interventions for treating genital Chlamydia trachomatis infection in pregnancy. Cochrane Database Syst Rev 2000, pp. CD000054–CD000054.

26.

Gall

Constantine

. Comparative evaluation of clindamycin versus clindamycin plus tobramycin in the treatment of acute pelvic inflammatory disease. Obstet Gynecol 1990; 75: 282–286.

27.

Miller

Martin

. Treatment of Chlamydia trachomatis infections in pregnant women. Drugs 2000; 60: 597–605.

28.

Hemsell

Little

Faro

. Comparison of three regimens recommended by the Centers for Disease Control and Prevention for the treatment of women hospitalized with acute pelvic inflammatory disease. Clin Infect Dis 1994; 19: 720–727.