Clinical comparison of cefotaxime versus the combination of gentamicin plus clindamycin in the treatment of polymicrobial soft-tissue surgical sepsis.

The safety and efficacy of cefotaxime versus a combination of gentamicin and clindamycin were compared in a prospective, randomized study of 98 surgical patients with polymicrobial soft-tissue infection or septicemia. Forty-nine patients received cefotaxime (20 mg/kg every six hours), and 49 received gentamicin (1 mg/kg every eight hours) plus clindamycin (5 mg/kg every six hours); all drugs were given intravenously. Overall, there was no statistical difference in clinical response to the two regimens, infection being eliminated in 73% of the patients treated with cefotaxime and 71% of those given gentamicin plus clindamycin. Adverse effects were mild and self-limited in both treatment groups, although three patients treated with gentamicin plus clindamycin experienced some loss of renal function. Most aerobic gram-negative rods were sensitive to both cefotaxime and gentamicin, but anaerobes were slightly more sensitive to clindamycin than to cefotaxime. Cefotaxime appeared to be at least as effective as gentamicin plus clindamycin in the treatment of polymicrobial soft-tissue infections and septicemia, and, in light of the loss of renal function associated with the gentamicin-clindamycin regimen, somewhat safer. The high failure rate among patients on both regimens with septicemia of unknown origin (five of the nine treated with cefotaxime and two of the four treated with gentamicin and clindamycin), however, indicates the critical role of surgical management in the treatment of polymicrobial soft-tissue sepsis.