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Clindamycin and gentamicin for aerobic and anaerobic sepsis
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.
Insights
Clindamycin and gentamicin combination therapy showed excellent results for severe bacterial infections, especially those involving anaerobic bacteria like Bacteroides fragilis.
Area of Science:
- Infectious Diseases
- Pharmacology
- Bacteriology
Background:
- Serious infections often involve polymicrobial flora, including anaerobes.
- Previous antibiotic regimens (penicillins, cephalosporins, aminoglycosides, chloramphenicol) had limited efficacy in some cases.
- Bacteroides fragilis is a common anaerobic pathogen in serious infections.
Purpose of the Study:
- To evaluate the efficacy of parenteral clindamycin phosphate and gentamicin sulfate in treating serious aerobic and anaerobic bacterial infections.
- To assess the role of clindamycin's activity against anaerobes in treatment outcomes.
Main Methods:
- A cohort of 38 adult patients with serious pleuropulmonary, soft-tissue, bone, and intra-abdominal infections were treated.
- Parenteral clindamycin and gentamicin were administered, with surgery as appropriate.
- Serum drug concentrations and clinical responses were monitored.
Main Results:
- Excellent clinical outcomes were observed with the clindamycin-gentamicin combination.
- Clindamycin demonstrated potent activity against anaerobic bacteria, including Bacteroides fragilis, with serum levels exceeding MICs.
- Gentamicin concentrations did not consistently exceed MICs for certain Gram-negative bacilli, despite susceptibility by disk diffusion.
Conclusions:
- The combination of clindamycin and gentamicin is effective for serious polymicrobial infections, particularly due to clindamycin's anaerobic coverage.
- Persistent colonization by certain bacteria and yeasts can prolong recovery in complex infections.