***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a prospect i ve , r and omized study of 96 patients after cesarean section who had endomyometritis , there was a therapeutic cure in 35 of 47 ( 74.5 % ) patients who received mezlocillin , in comparison with 42 of 49 ( 85.7 % ) patients who received clindamycin and gentamicin ( p = 0.17 ) . Only wound infections in the study population were predictive for therapeutic outcome . Four of the five patients who received mezlocillin and none of the three patients who received clindamycin and gentamicin with wound infections were associated with therapeutic failures . This suggests mezlocillin may not be as effective as clindamycin and gentamicin in successfully treating wound infections . The number of vaginal examinations in patients sectioned for cephalopelvic disproportion was associated with increased febrile morbidity , suggesting that an excessive number of vaginal examinations should be avoided in the laboring patient The efficacy of mezlocillin versus cefoxitin versus clindamycin plus gentamicin was evaluated in 152 patients with postpartum endometritis . There were no statistically significant differences in rate of cure among the three groups ( 87 % with mezlocillin , 82 % with cefoxitin , and 92 % with clindamycin-gentamicin ) . There were no severe adverse reactions observed in any of the three treatment regimens . Mezlocillin is as safe and effective as cefoxitin and clindamycingentamicin for treatment of postpartum endometritis Using a system of r and om selection in patients with severe obstetric — gynecologic infections .  parenteral penicillia-kanamycin was given to 23 women and clindaniycin-kanamycin was given to 21 .  Therapeutic response to the two antibiotic regimens was similar ; no significant differences were noted in either the posttreatment fever index or the numbers of women requiring other therapy . There was a failure of response to the penicillia-kanamycin regimen in those women with Bacteroides fragilis infection and to the clindamycin-kanamycin regimen in some of the women with an Enterococcus infection . The implication s of these findings for the future selection of antibiotics for patients with severe obstetric-gynecologic infections are discussed Post-cesarean-section  endometritis therapy usually combines an intravenous administered antibiotic followed , once fever has remitted , by an oral or intramuscular course of 7 - 10 days of the same antibiotic . From November 1993 to May 1994 and trying to reduce the length of the treatment we conducted a r and omized , comparative study between the conventional post-C-section endometritis treatment  used at the Hospital Central Militar  ( long course ) and a short parenteral treatment with the same antibiotics .  Thirty one patients were r and omized in the short course group and 32 in the long course group . Only in the long course group there was a patient with persistence of infection after ten days of antibiotic treatment ( p > 0.05 ) . The short course regimen brought additional advantages as reduction in treatment days as well as discomfort for the intramuscular administration of antibiotics . This observation suggests that a short course of antibiotics based on the patient 's clinical response is a safe and less expensive alternative in the treatment of post-C-section endometritis Objective : The purpose of this study was to compare the clinical efficacy and safety of trospectomycin sulfate with that of clindamycin phosphate , both with aztreonam , for the treatment of obstetric and gynecologic infections . Methods : In a double-blind , multicenter , prospect i ve r and omized study , 579 patients with either endometritis following cesarean delivery or pelvic cellulitis following hysterectomy were enrolled and received medication . Administered was either trospectomycin sulfate 500 mg IV every 8 h or clindamycin phosphate 900 mg IV every 8 h in a 1:1 r and omization ratio . Both groups of patients received aztreonam 1 g IV every 8 h. The patients were followed for clinical responses and side effects . Results : The cure rate for the trospectomycin sulfate arm was 91.8 % and for clindamycin phosphate arm it was 88.4 % ( P = 0.218 ) . The adverse events were similar in both groups . Conclusions : Trospectomycin was as effective as clindamycin , when both were combined with aztreonam , in treatment of obstetric and gynecologic infections Objective To evaluate whether once-daily gentamicin dosing is as effective as the traditional 8-hour regimen for the treatment of postpartum endometritis . Methods Postpartum women with endometritis were r and omized to receive gentamicin 5 mg/kg as a single daily dose or 1.75 mg/kg every 8 hours . All subjects also received clindamycin . Each participant had a peak serum gentamicin level of at least 5.0 μg/mL within the first 24 hours . The dosing regimens were compared by analyzing the number of hours that patients were febrile , the length of hospital stay , occurrence of complications , pharmacy costs , and nursing time required to administer the regimens . Results The study group ( n = 62 ) and the control group ( n = 65 ) were similar in demographic characteristics and the presence of endometritis risk factors . No differences were found between the groups in the number of patients who completed therapy without complications , required changes in antibiotics , or required readmission for endometritis . The groups did not differ in the number of hours that patients remained febrile after the start of therapy or in the length of hospital stay . No patient in the study group had an initial peak serum concentration less than 5.0 μg/mL , whereas 24 patients in the control group had initial peak serum concentrations less than 5.0 μg/mL and required dose adjustment , a statistically significant difference ( P < .001 ) . Pharmacy costs averaged $ 16.12 ± 5.68 for the study group and $ 41.75 ± 17.41 for the control group , also a significant difference ( P < .001 ) . Nurse tasking time averaged 13.62 ± 2.56 minutes for the study group and 28.06 ± 8.77 minutes for the control group ( P < .001 ) . Conclusion In patients with postpartum endometritis , once-daily gentamicin dosing provides consistently high peak serum levels of gentamicin , requires less nurse tasking time , costs less , and is as effective as the 8-hour dosing regimen A prospect i ve r and omized study of the treatment of postpartum endometritis was conducted with 43 patients . The bacterial origin of the infection was determined by uterine aspiration . Treatment was successful in 17 of the 19 patients receiving ampicillin ( 12 g/d ) and in 21 of the 24 patients receiving clindamycin ( 2.4 g/d ) plus gentamicin ( 5.1 mg/kg daily ) & NA ; Sixty women with the diagnosis of puerperal endometritis were r and omized to receive either moxalactam ( n = 29 ) or the combination of clindamycin and tobramycin ( n = 31 ) as therapy for their infection . Endometrial bacteriology consisted of mixed flora , both aerobic and anaerobic gram‐positive and gram‐negative organisms . Clinical cure was achieved in 27 ( 93 % ) of the moxalactam‐treated patients and 28 ( 90 % ) of those given combination therapy . The two failures of moxalactam therapy were associated with enterococcal infection . Failures of clindamycin/tobramycin therapy were due to enterococcal infection , abscess formation , and moderately severe diarrhea . This study indicates that moxalactam  is as effective and safe as the combination of clindamycin/tobramycin for the treatment of postpartum endometritis A double-blind comparison of clindamycin plus gentamicin versus moxalactam plus placebo was performed for the treatment of endomyometritis after cesarean section delivery . Entry criteria were uterine tenderness , temperature greater than or equal to 101 degrees F , and leukocytosis . Uterine specimens were obtained for culture via a single-lumen transcervical catheter . Bacteremia occurred in 10 % of patients . Among the 57 patients treated with clindamycin plus gentamicin  , there were two clinical failures and four side effect failures ( diarrhea in two , allergic reaction in two ) . Among the 56 patients in the moxalactam group , there were four clinical failures and one side effect failure ( diarrhea ) . Both regimens had good cure rates , with no significant differences in cures or postoperative hospital stay A protected , triple-lumen transcervical culture method was used to recover organisms from the endometrium . At least one facultative or one anaerobic species of bacteria was recovered from 82 % of the patients , and genital mycoplasmas were recovered from 76 % of the women with endometritis .  Bacteria together with genital mycoplasmas were present in 61 % of the women , bacteria alone were present in 20 % , genital mycoplasmas alone were present in 16 % , and Chlamydia trachomatis was isolated from 2 % of the patients . The most common organisms included Gardnerella vaginalis , Peptococcus spp . , Bacteroides spp . , Staphylococcus epidermidis , group B Streptococcus , and Ureaplasma urealyticum . A r and omized , double-blind regimen of either piperacillin or cefoxitin was equally successful in treating the postpartum endometritis One hundred fifty-two women who received cefazolin prophylaxis and subsequently developed postpartum endometritis were r and omized to treatment with either ticarcillin/clavulanic acid ( 75 ) or clindamycin-gentamicin ( 77 ) . Bacteria isolated from the endometrium were predominantly facultative anaerobic bacteria . The ratio of facultative anaerobes to obligate anaerobes was 3:1 . Nineteen percent of the women were bacteremic , with mycoplasma the organism most frequently isolated from venous blood specimens . Cure rates were similar for both groups : ticarcillin/clavulanic acid 85 % and clindamycin-gentamicin 81 % . The advantages of ticarcillin/clavulanic acid are an increased spectrum of activity against beta-lactamase-producing bacteria , less toxicity , and lower cost The most common adverse outcome associated with vaginal delivery is endometritis . It plays a significant role in postpartum morbidity and mortality . There is considerable evidence to support the idea that a single dose of antibiotic after vaginal delivery might decrease the incidence of postpartum endometritis . In this study the evaluation of the efficacy of antibiotic prophylaxis was based upon comparison of a group of patients given a single dose of Amox-CA ( Augmentin ) with a group of patients  without treatment . The study was performed in the Department of Obstetrics and Gynecology of the A. Béclère Public Hospital , Clamart , France ( Paris-Sud University ) . The patients who were the subject of the study had delivered vaginally during the period of 1 year , and were free of any clinical diagnosis of chorioamnionitis or other extragenital infection , had a maternal temperature of less than 38 degrees C during labor and 1 h after delivery , and had no history of allergy to penicillins or cephalosporins . After application of exclusion criteria , 1373 patients were r and omized and 1291 included 610 in Group I given Amox-CA  and 681 in Group II without any antibiotic . A single dose of 1.2 g of Amox-CA was given by intravenous injection , 1 h after delivery , in Group I. Patients of Group II received no injection .  Postpartum status was evaluated before the patient left hospital and 2 weeks later . The two groups were similar in terms of demographic and clinical parameters . Four patients developed endometritis in Group I ( 4/610 , 0.66 % ) . Sixteen patients in Group II developed endometritis ( 16/680 , 2.38 % ) ( P = 0.013 ; 95 % confidence interval ( CI ) , 0.36 - 3.08 % ) . ( ABSTRACT TRUNCATED AT 250 WORDS Seventy patients with postpartum endomyometritis were treated with either intravenous mezlocillin ( 16 gm/day ) or ampicillin ( 8 gm/day ) in a prospect i ve , r and omized , double-blind comparison . Endocervical dilatation was routinely performed . Clindamycin ( 2 gm/day ) was added if patients failed to improve within 48 hours of beginning therapy . Pretreatment clinical and microbiologic profiles were comparable in the two groups . Bacteremia was documented in 21 patients ( 30 % ) . Anaerobic cocci and Bacteroides spp . ( non-B. fragilis ) comprised 19 of 29 ( 65 % ) blood isolates . Thirty of 33 mezlocillin-treated patients ( 91 % ) and 30 of 37 ampicill 
    Output:
    
There were no differences between groups for the outcomes of allergic reactions .
AUTHORS ' CONCLUSIONS The combination of clindamycin and gentamicin is appropriate for the treatment of endometritis .
Regimens with good activity against penicillin-resistant anaerobic bacteria are better than those with poor activity against penicillin-resistant anaerobic bacteria .
There is no evidence that any one regimen is associated with fewer side-effects .
Following clinical improvement of uncomplicated endometritis which has been treated with intravenous therapy , the use of additional oral therapy has not been proven to be beneficial