Superiority of aztreonam/clindamycin compared with gentamicin/clindamycin in patients with penetrating abdominal trauma

Timothy Fabian, Mary M. Hess, Martin Croce, Robert S. Wilson, Samuel E. Wilson, Scott L. Charland, John H. Rodman, Bradley Boucher

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

There were 73 evaluable patients entered into a prospective, double-blinded trial comparing aztreonam/clindamycin ( A C) to gentamicin/clindamycin ( G C) for the prevention of infection after penetrating abdominal trauma. Aztreonam was administered at a dosage of 2 g every 8 hours and gentamicin at 5 mg/kg for the first 24 hours and then adjusted by serum monitoring to a peak of 6 to 8 μg/mL and a trough of less than 2 μg/mL; all patients received 900 mg of clindamycin every 8 hours. Patients with colon wounds received 4 days of antibiotics, and the remaining patients received a 24-hour course. Gunshot wounds occurred in 69% of patients: 74% of all patients had some hollow viscus injury, and 26% had only solid viscus injury. The groups were well matched according to abdominal trauma index, percentage with colon injury, and transfusion requirements. Failures occurred in eight patients (11%): two wound infections, five intra-abdominal infections, and one case of necrotizing fasciitis. Seven infections occurred in 36 (19%) G C patients compared with 1 in 37 (3%) A C patients (p < 0.03). The hospital stay was 12 ± 11 days for G/C patients and 8 ± 7 for A C patients (p < 0.12). The superiority of the A C regimen may be partially attributable to relative underdosing of gentamicin (approximately half of the patients had inadequate levels after 24 hours) combined with a favorable pharmacokinetic profile (significantly prolonged half-life) of aztreonam in this clinical setting.

Original languageEnglish (US)
Pages (from-to)291-296
Number of pages6
JournalThe American Journal of Surgery
Volume167
Issue number3
DOIs
StatePublished - Jan 1 1994

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Aztreonam
Clindamycin
Gentamicins
Wounds and Injuries
Viscera
Colon
Intraabdominal Infections
Necrotizing Fasciitis
Gunshot Wounds
Wound Infection
Infection
Half-Life
Length of Stay

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Superiority of aztreonam/clindamycin compared with gentamicin/clindamycin in patients with penetrating abdominal trauma. / Fabian, Timothy; Hess, Mary M.; Croce, Martin; Wilson, Robert S.; Wilson, Samuel E.; Charland, Scott L.; Rodman, John H.; Boucher, Bradley.

In: The American Journal of Surgery, Vol. 167, No. 3, 01.01.1994, p. 291-296.

Research output: Contribution to journalArticle

Fabian, Timothy ; Hess, Mary M. ; Croce, Martin ; Wilson, Robert S. ; Wilson, Samuel E. ; Charland, Scott L. ; Rodman, John H. ; Boucher, Bradley. / Superiority of aztreonam/clindamycin compared with gentamicin/clindamycin in patients with penetrating abdominal trauma. In: The American Journal of Surgery. 1994 ; Vol. 167, No. 3. pp. 291-296.
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