A double-blind comparison of clindamycin with penicillin plus chloramphenicol in treatment of septic abortion.

The responses to therapy with either clindamycin alone or penicillin plus chloramphenicol in 77 patients with septic abortions were compared in a randomized, double-blind study. Although fever index and duration of hospitalization were similar for both groups of patients, significantly more patients in the group that received clindamycin developed major complications (P less than 0.05). This is believed to result from clindamycin's lack of activity against aerobic gram-negative bacilli. Aggressive management that included early uterine evacuation and broad-spectrum antibiotics effective against both aerobic and anaerobic bacteria was the key to reduced morbidity and mortality rates in treatment of septic abortion. For patients treated with clindamycin, early uterine evacuation appeared more important than antibiotic therapy (P less than 0.005). Bacteremia was documented in a total of 29 patients (38%). Bacteremia was polymicrobial in eight patients (28%) and involved anaerobes exclusively in 18 (62%), aerobes exclusively in nine (31%), and both aerobes and anaerobes in two (7%). The organisms most frequently isolated were Bacteroides (other than Bacteroides fragilis), Peptostreptococcus, and Escherichia coli.