March 1988

Prospective Study Comparing Imipenem-Cilastatin With Clindamycin and Gentamicin for the Treatment of Serious Surgical Infections

Author Affiliations

From the Departments of Surgery (Drs Hackford and Reinhold), Medicine (Infectious Disease Division) (Drs Tally and Barza), and Community Health (Dr Gorbach), Tufts University School of Medicine and New England Medical Center Hospitals, Boston.

Arch Surg. 1988;123(3):322-326. doi:10.1001/archsurg.1988.01400270056008

• Surgical infection remains a leading cause of hospital morbidity and mortality. We compared the efficacy and toxicity of imipenem—cilastatin sodium in 32 patients with that of clindamycin phosphate and gentamicin sulfate in 25 patients. In the imipenem-cilastatin group, 87.5% had a favorable outcome, with a 12.5% failure rate and 13 adverse reactions. In the clindamycin-gentamicin group, 80% had a favorable outcome, with a 20% failure rate and ten adverse reactions. Two significant superinfections with Pseudomonas and Candida were noted in patients treated with impenem-cilastatin. Each group had one case of Clostridium difficile—associated colitis. Cost analysis showed no differences between treatment arms, except in the appendicitis subgroup. For serious surgical infections, single-agent therapy with imipenem-cilastatin appears to be as efficacious as combination therapy with clindamycin and gentamicin.

(Arch Surg 1988;123:322-326)