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Clindamycin and Gentamicin

Clindamycin and Gentamicin Abstract Thirty-eight adult patients with serious pleuropulmonary, soft-tissue, bone, and intra-abdominal infections caused by combinations of aerobic, facultative, and anaerobic bacteria were treated with parenterally given clindamycin phosphate and gentamicin sulfate and surgery when appropriate. Nine had associated bacteremia. In 29, infections failed to respond to other therapeutic regimens, which included penicillins, cephalosporins, aminoglycosides, and chloramphenicol. Results with clindamycin and gentamicin were excellent and were attributed primarily to the activity of clindamycin against anaerobes, particularly Bacteroides fragilis. Serum concentrations of clindamycin surpassed by manyfold the minimal inhibitory concentrations (MICs) for anaerobes. Serum concentrations of gentamicin did not consistently surpass the MICs for Enterobacteriaceae and Pseudomonas aeruginosa, although those organisms were consistently gentamicinsusceptible by disk diffusion susceptibility tests. Persistent colonization with Enterobacteriaceae, P aeruginosa, enterococci, or Candida were common, and occasionally they were significant in prolonging the clinical courses of patients with extensive infections. (Arch Intern Med 137:28-38, 1977) References 1. Gorbach SL, Bartlett JG: Anaerobic infections . N Engl J Med 290:1177-1184, 1237-1245, 1289-1294, 1974.Crossref 2. Finegold SM, Bartlett JG, Chow AW, et al: Management of anaerobic infections . Ann Intern Med 83:375-389, 1975.Crossref 3. Fass RJ: Lincomycin and clindamycin , in Kagan BM (ed): Antimicrobial Therapy . Philadelphia, WB Saunders Co, 1974, p 83. 4. Bartlett JG, Sutter VL, Finegold SM: Treatment of anaerobic infections with lincomycin and clindamycin . N Engl J Med 287:1006-1010, 1972.Crossref 5. Fass RJ, Scholand JF, Hodges GR, et al: Clindamycin in the treatment of serious anaerobic infections . Ann Intern Med 78:853-859, 1973.Crossref 6. Haldane EV, Van Rooyen CE: Treatment of severe Bacteroides infections with parenteral clindamycin . Can Med Assoc J 107:1177-1181, 1972. 7. Douglas RL, Kislak JW: Treatment of Bacteroides fragilis bacteremia with clindamycin . J Infect Dis 128:569-571, 1973.Crossref 8. Thadepalli H, Gorbach SL, Broido PW, et al: Abdominal trauma, anaerobes, and antibiotics . Surg Gynecol Obstet 137:270-276, 1973. 9. Levison ME, Bran JL, Ries K: Treatment of anaerobic bacterial infections with clindamycin2-phosphate . Antimicrob Agents Chemother 5:276-280, 1974.Crossref 10. Sen P, Tecson F, Kapila R, et al: Clindamycin in the oral treatment of putative anaerobic pneumonias . Arch Intern Med 134:73-77, 1974.Crossref 11. Chow AW, Montgomerie JZ, Guze LB: Parenteral clindamycin therapy for severe anaerobic infections . Arch Intern Med 134:78-82, 1974.Crossref 12. Gorbach SL, Thadepalli H: Clindamycin in pure and mixed anaerobic infections . Arch Intern Med 134:87-92, 1974.Crossref 13. Dickinson PCT, Saphyakhajon P: Treatment of Bacteroides infection with clindamycin2-phosphate . Can Med Assoc J 111:945-949, 1974. 14. Swenson RM, Michaelson TC, Daly MJ, et al: Clindamycin in infections of the female genital tract . Obstet Gynecol 44:699-702, 1974. 15. Ledger WJ, Kriewall TJ, Sweet RL, et al: The use of parenteral clindamycin in the treatment of obstetric-gynecologic patients with severe infections . Obstet Gynecol 43:490-497, 1974. 16. Jackson GG: Gentamicin and tobramycin , in Kagan BM (ed): Antimicrobial Therapy . Philadelphia, WB Saunders Co, 1974, p 42. 17. Fass RJ, Rotilie CA, Prior RB: Interaction of clindamycin and gentamicin in vitro . Antimicrob Agents Chemother 6:582-587, 1974.Crossref 18. Weinstein WM, Onderdonk AB, Bartlett JG, et al: Experimental intra-abdominal abscesses in rats: Development of an experimental model . Infect Immun 10:1250-1255, 1974. 19. Onderdonk AB, Weinstein WM, Sullivan NM, et al: Experimental intra-abdominal abscesses in rats: Quantitative bacteriology of infected animals . Infect Immun 10:1256-1259, 1974. 20. Weinstein WM, Onderdonk AB, Bartlett JG, et al: Antimicrobial therapy of experimental intra-abdominal sepsis . J Infect Dis 132:282-286, 1975.Crossref 21. Rotilie CA, Fass RJ, Prior RB, et al: Microdilution technique for antimicrobial susceptibility testing of anaerobic bacteria . Antimicrob Agents Chemother 7:311-315, 1975.Crossref 22. Sabath LD, Toftegaard I: Rapid microassays for clindamycin and gentamicin when present together and the effect of pH and of each on the antibacterial activity of the other . Antimicrob Agents Chemother 6:54-59, 1974.Crossref 23. Thadepalli H, Gorbach S, Bartlett J: Apparent failure of chloramphenicol in anaerobic infections . Read before the 13th Interscience Conference on Antimicrobial Agents and Chemotherapy, Sept 19-21, 1973 , Washington, DC. 24. Chow AW, Guze LB: Bacteroidaceae bacteremia: Clinical experience with 112 patients . Medicine 53:93-126, 1974.Crossref 25. Wilson WR, Martin WJ, Wilkowske CJ, et al: Anaerobic bacteremia . Mayo Clin Proc 47:639-646, 1972. 26. Bodner SJ, Koenig MG, Goodman JS: Bacteremic Bacteroides infections . Ann Intern Med 73:537-544, 1970.Crossref 27. Nobles ER Jr: Bacteroides infections . Ann Surg 177:601-606, 1973. 28. Bauer AW, Kirby WMM, Sherris JC, et al: Antibiotic susceptibility testing by a standardized single-disk method . Am J Clin Pathol 45:493-496, 1966. 29. Kaye D, Levison ME, Labovitz ED: The unpredictability of serum concentrations of gentamicin: Pharmacokinetics of gentamicin in patients with normal and abnormal renal function . J Infect Dis 130:150-154, 1974.Crossref 30. National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing: Performance standards for antimicrobial disc susceptibility tests, as used in clinical laboratories , in Balows A (ed): Current Techniques for Antibiotic Susceptibility Testing . Springfield,Charles C Thomas Publisher, 1974, p 138. 31. Jackson GG, Riff LJ: Pseudomonas bacteremia: Pharmacologic and other bases for failure of treatment with gentamicin . J Infect Dis 124:S185-S191, 1971.Crossref 32. Bartlett JG, Louie TJ, Onderdonk AB, et al: Whither the enterococcus? Read before the 15th Interscience Conference on Antimicrobial Agents and Chemotherapy, Sept 21-26, 1975 , Washington, DC. 33. Fass RJ, Saslaw S: Clindamycin: Clinical and laboratory evaluation of parenteral therapy . Am J Med Sci 263:369-382, 1972.Crossref 34. Tedesco FJ, Barton RW, Alpers DH: Clindamycin-associated colitis: A prospective study . Ann Intern Med 81:429-433, 1973.Crossref 35. Wilfert JN, Burke JP, Bloomer HA, et al: Renal insufficiency associated with gentamicin therapy . J Infect Dis 124:S148-S153, 1971.Crossref 36. Dahlgren JG, Anderson ET, Hewitt WL: Gentamicin blood levels: A guide to nephrotoxicity . Antimicrob Agents Chemother 8:58-62, 1975.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1977.03630130014006
Publisher site
See Article on Publisher Site

Abstract

Abstract Thirty-eight adult patients with serious pleuropulmonary, soft-tissue, bone, and intra-abdominal infections caused by combinations of aerobic, facultative, and anaerobic bacteria were treated with parenterally given clindamycin phosphate and gentamicin sulfate and surgery when appropriate. Nine had associated bacteremia. In 29, infections failed to respond to other therapeutic regimens, which included penicillins, cephalosporins, aminoglycosides, and chloramphenicol. Results with clindamycin and gentamicin were excellent and were attributed primarily to the activity of clindamycin against anaerobes, particularly Bacteroides fragilis. Serum concentrations of clindamycin surpassed by manyfold the minimal inhibitory concentrations (MICs) for anaerobes. Serum concentrations of gentamicin did not consistently surpass the MICs for Enterobacteriaceae and Pseudomonas aeruginosa, although those organisms were consistently gentamicinsusceptible by disk diffusion susceptibility tests. Persistent colonization with Enterobacteriaceae, P aeruginosa, enterococci, or Candida were common, and occasionally they were significant in prolonging the clinical courses of patients with extensive infections. (Arch Intern Med 137:28-38, 1977) References 1. Gorbach SL, Bartlett JG: Anaerobic infections . N Engl J Med 290:1177-1184, 1237-1245, 1289-1294, 1974.Crossref 2. Finegold SM, Bartlett JG, Chow AW, et al: Management of anaerobic infections . Ann Intern Med 83:375-389, 1975.Crossref 3. Fass RJ: Lincomycin and clindamycin , in Kagan BM (ed): Antimicrobial Therapy . Philadelphia, WB Saunders Co, 1974, p 83. 4. Bartlett JG, Sutter VL, Finegold SM: Treatment of anaerobic infections with lincomycin and clindamycin . N Engl J Med 287:1006-1010, 1972.Crossref 5. Fass RJ, Scholand JF, Hodges GR, et al: Clindamycin in the treatment of serious anaerobic infections . Ann Intern Med 78:853-859, 1973.Crossref 6. Haldane EV, Van Rooyen CE: Treatment of severe Bacteroides infections with parenteral clindamycin . Can Med Assoc J 107:1177-1181, 1972. 7. Douglas RL, Kislak JW: Treatment of Bacteroides fragilis bacteremia with clindamycin . J Infect Dis 128:569-571, 1973.Crossref 8. Thadepalli H, Gorbach SL, Broido PW, et al: Abdominal trauma, anaerobes, and antibiotics . Surg Gynecol Obstet 137:270-276, 1973. 9. Levison ME, Bran JL, Ries K: Treatment of anaerobic bacterial infections with clindamycin2-phosphate . Antimicrob Agents Chemother 5:276-280, 1974.Crossref 10. Sen P, Tecson F, Kapila R, et al: Clindamycin in the oral treatment of putative anaerobic pneumonias . Arch Intern Med 134:73-77, 1974.Crossref 11. Chow AW, Montgomerie JZ, Guze LB: Parenteral clindamycin therapy for severe anaerobic infections . Arch Intern Med 134:78-82, 1974.Crossref 12. Gorbach SL, Thadepalli H: Clindamycin in pure and mixed anaerobic infections . Arch Intern Med 134:87-92, 1974.Crossref 13. Dickinson PCT, Saphyakhajon P: Treatment of Bacteroides infection with clindamycin2-phosphate . Can Med Assoc J 111:945-949, 1974. 14. Swenson RM, Michaelson TC, Daly MJ, et al: Clindamycin in infections of the female genital tract . Obstet Gynecol 44:699-702, 1974. 15. Ledger WJ, Kriewall TJ, Sweet RL, et al: The use of parenteral clindamycin in the treatment of obstetric-gynecologic patients with severe infections . Obstet Gynecol 43:490-497, 1974. 16. Jackson GG: Gentamicin and tobramycin , in Kagan BM (ed): Antimicrobial Therapy . Philadelphia, WB Saunders Co, 1974, p 42. 17. Fass RJ, Rotilie CA, Prior RB: Interaction of clindamycin and gentamicin in vitro . Antimicrob Agents Chemother 6:582-587, 1974.Crossref 18. Weinstein WM, Onderdonk AB, Bartlett JG, et al: Experimental intra-abdominal abscesses in rats: Development of an experimental model . Infect Immun 10:1250-1255, 1974. 19. Onderdonk AB, Weinstein WM, Sullivan NM, et al: Experimental intra-abdominal abscesses in rats: Quantitative bacteriology of infected animals . Infect Immun 10:1256-1259, 1974. 20. Weinstein WM, Onderdonk AB, Bartlett JG, et al: Antimicrobial therapy of experimental intra-abdominal sepsis . J Infect Dis 132:282-286, 1975.Crossref 21. Rotilie CA, Fass RJ, Prior RB, et al: Microdilution technique for antimicrobial susceptibility testing of anaerobic bacteria . Antimicrob Agents Chemother 7:311-315, 1975.Crossref 22. Sabath LD, Toftegaard I: Rapid microassays for clindamycin and gentamicin when present together and the effect of pH and of each on the antibacterial activity of the other . Antimicrob Agents Chemother 6:54-59, 1974.Crossref 23. Thadepalli H, Gorbach S, Bartlett J: Apparent failure of chloramphenicol in anaerobic infections . Read before the 13th Interscience Conference on Antimicrobial Agents and Chemotherapy, Sept 19-21, 1973 , Washington, DC. 24. Chow AW, Guze LB: Bacteroidaceae bacteremia: Clinical experience with 112 patients . Medicine 53:93-126, 1974.Crossref 25. Wilson WR, Martin WJ, Wilkowske CJ, et al: Anaerobic bacteremia . Mayo Clin Proc 47:639-646, 1972. 26. Bodner SJ, Koenig MG, Goodman JS: Bacteremic Bacteroides infections . Ann Intern Med 73:537-544, 1970.Crossref 27. Nobles ER Jr: Bacteroides infections . Ann Surg 177:601-606, 1973. 28. Bauer AW, Kirby WMM, Sherris JC, et al: Antibiotic susceptibility testing by a standardized single-disk method . Am J Clin Pathol 45:493-496, 1966. 29. Kaye D, Levison ME, Labovitz ED: The unpredictability of serum concentrations of gentamicin: Pharmacokinetics of gentamicin in patients with normal and abnormal renal function . J Infect Dis 130:150-154, 1974.Crossref 30. National Committee for Clinical Laboratory Standards Subcommittee on Antimicrobial Susceptibility Testing: Performance standards for antimicrobial disc susceptibility tests, as used in clinical laboratories , in Balows A (ed): Current Techniques for Antibiotic Susceptibility Testing . Springfield,Charles C Thomas Publisher, 1974, p 138. 31. Jackson GG, Riff LJ: Pseudomonas bacteremia: Pharmacologic and other bases for failure of treatment with gentamicin . J Infect Dis 124:S185-S191, 1971.Crossref 32. Bartlett JG, Louie TJ, Onderdonk AB, et al: Whither the enterococcus? Read before the 15th Interscience Conference on Antimicrobial Agents and Chemotherapy, Sept 21-26, 1975 , Washington, DC. 33. Fass RJ, Saslaw S: Clindamycin: Clinical and laboratory evaluation of parenteral therapy . Am J Med Sci 263:369-382, 1972.Crossref 34. Tedesco FJ, Barton RW, Alpers DH: Clindamycin-associated colitis: A prospective study . Ann Intern Med 81:429-433, 1973.Crossref 35. Wilfert JN, Burke JP, Bloomer HA, et al: Renal insufficiency associated with gentamicin therapy . J Infect Dis 124:S148-S153, 1971.Crossref 36. Dahlgren JG, Anderson ET, Hewitt WL: Gentamicin blood levels: A guide to nephrotoxicity . Antimicrob Agents Chemother 8:58-62, 1975.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1977

References