Document Detail


A prospective randomized study of moxalactam versus gentamicin and clindamycin in penetrating abdominal trauma.
MedLine Citation:
PMID:  3726718     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We conducted a randomized, prospective study of moxalactam versus gentamicin plus clindamycin in 42 patients with penetrating abdominal trauma. Patients were randomized to receive intravenously either 2 grams of moxalactam every 12 hours or 80 milligrams of gentamicin every eight hours and 600 milligrams of clindamycin every six hours. Antibiotics were administered preoperatively and continued for a minimum of five days if hollow viscus injury occurred. For those without hollow viscus injury, only those patients receiving a minimum of three days of antibiotics were evaluated. A single intramuscular dose of 10 milligrams of vitamin K was also administered to all patients in the moxalactam group. There were 39 males and three females with a mean age of 33 years. Twenty patients received moxalactam and 22 received gentamicin plus clindamycin. The mechanism of injury was gunshot wound in 32 patients and stab wounds in ten patients. Eight patients in each group sustained injuries to the small intestine or colon, or both. The mean injury severity score was 22.6 and 21.2 in the single and double antibiotic regimen, respectively. The mean duration of antibiotic therapy was 5.8 and 7.0 days in the single and double antibiotic group, respectively. No infectious complications occurred in the moxalactam group whereas five infections occurred in four patients in the gentamicin plus clindamycin group (p less than 0.05). These infections included one intra-abdominal abscess, two wound infections and two episodes of necrotizing fasciitis of the wound and abdominal wall. There were no complications attributable to moxalactam therapy. The over-all mortality rate was zero per cent. The total pharmacy cost of a five day course of moxalactam plus a single dose of vitamin K is $204.67 compared with $226.00 for a similar course of gentamicin plus clindamycin. We conclude that: moxalactam is at least, if not more, effective in preventing infectious complications after penetrating abdominal trauma compared with gentamicin plus clindamycin; moxalactam is safe in the doses used when combined with vitamin K, and 3, moxalactam is more cost-effective than gentamicin plus clindamycin dual antibiotic therapy.
Authors:
D J Kreis; D Augenstein; O Martinez; M Echenique; G Plasencia; J J Vopal; P Byers; G A Gomez
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Surgery, gynecology & obstetrics     Volume:  163     ISSN:  0039-6087     ISO Abbreviation:  Surg Gynecol Obstet     Publication Date:  1986 Jul 
Date Detail:
Created Date:  1986-08-07     Completed Date:  1986-08-07     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0101370     Medline TA:  Surg Gynecol Obstet     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1-4     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Abdominal Injuries / drug therapy*
Adolescent
Adult
Clindamycin / therapeutic use*
Drug Evaluation
Drug Therapy, Combination
Female
Gentamicins / therapeutic use*
Humans
Male
Moxalactam / therapeutic use*
Premedication*
Prospective Studies
Random Allocation
Vitamin K / therapeutic use
Wounds, Penetrating / drug therapy*
Chemical
Reg. No./Substance:
0/Gentamicins; 12001-79-5/Vitamin K; 18323-44-9/Clindamycin; 64952-97-2/Moxalactam

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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