Ampicillin/sulbactam vs clindamycin/gentamicin in the treatment of postpartum endometritis

OBJECTIVE: To evaluate the efficacy and safety of ampicillin/sulbactam with those of clindamycin/gentamicin. STUDY DESIGN: A prospective, randomized clinical trial of patients with the diagnosis of postpartum endometritis. Intravenous ampicillin, 2.0 g, combined with 1.0 g sulbactam was administered every six hours or intravenous clindamycin, 900 mg, plus gentamicin, 1.5 mg/kg (not to exceed 150 mg unless gentamicin levels were obtained) every eight hours. Endometrial and blood specimens were obtained for culture and antibiotic susceptibility testing. RESULTS: One hundred twenty-nine hospitalized women with the diagnosis of endometritis were enrolled. Both treatment regimens were equally effective. At the end of treatment, 42 of 51 (82%) ampicillin/ sulbactam-treated patients achieved clinical cure in comparison to 47 of 56 (84%) patients in the clindamycin/gentamicin group. Respective bacterial eradication rates of 86% and 84% for each treatment group were seen. Both antibiotic regimens were well tolerated, with no statistically significant difference in the incidence of adverse experiences. CONCLUSION: The two antibiotic regimens were equally effective for a clinical cure, bacterial eradication and incidence of adverse experiences.