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A Prospective Randomized Comparison in the Therapy of Mixed Aerobic/Anaerobic Infections

Lindsay E. Nicolle, MD, FRCP(C); Godfrey K. M. Harding, MD, FRCP(C); Thomas J. Louie, MD, FRCP(C); Margaret J. Thomson, RN; Robert J. Blanchard, MD, FRCS(C)

Arch Surg. 1986;121(8):891-896.

Abstract
• The efficacy of therapy with cefoxitin sodium plus tobramycin sulfate, with the tobramycin therapy discontinued if no cefoxitin-resistant pathogens grew from appropriate cultures, was compared with clindamycin phosphate plus tobramycin therapy in mixed aerobic/anaerobic intra-abdominal and female pelvic infections. Of 96 evaluable patients, 39 (76%) of 51 randomized to cefoxitin and 38 (84%) of 45 randomized to clindamycin were cured and an additional seven (14%) of 51 and three (6.7%) of 45, respectively, were improved. Bacteroides fragilis "group" was isolated from 44 (54%) of 82 patients with appropriate specimens. Duration of aminoglycoside therapy was significantly shorter in patients randomized to cefoxitin and tobramycin (mean, 4.1±1.8 days vs 7.0±3.2 days). There was a tendency to greater nephrotoxic reactions in patients randomized to clindamycin and tobramycin. We conclude that cefoxitin plus tobramycin with selective early discontinuation of aminoglycoside therapy is an acceptable regimen for the therapy of mixed aerobic/anaerobic infections.

(Arch Surg 1986;121:891-896)

Author Affiliations
From the Department of Medicine, Section of Infectious Diseases (Drs Nicolle, Harding, and Louie), Department of Medical Microbiology (Drs Nicolle, Harding, and Louie and Mrs Thomson), and the Department of Surgery (Dr Blanchard), University of Manitoba, Winnipeg.

Footnotes
Accepted for publication Jan 23, 1986.

Reprint requests to Infectious Diseases, St Boniface General Hospital, 409 Tache Ave, Winnipeg, Manitoba, Canada R2H 2A6 (Dr Harding).

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