***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 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 ampicillin-treated patients ( 81 % ) responded to initial therapy ( P greater than 0.4 ) . Resolution was noted after the addition of clindamycin in all ten nonresponders ; two of these patients also required surgical wound debridement . Objective parameters of clinical response were not significantly different in the two treatment groups . Side effects of mezlocillin therapy were minimal . We conclude that mezlocillin and ampicillin are equally effective and safe for therapy of postpartum endomyometritis . That mezlocillin was not superior to ampicillin , despite exp and ed activity against B. fragilis and members of Enterobacteriaceae , suggests that these pathogens are less important than was previously considered in postpartum endomyometritis A prospect i ve , multicenter , open-label r and omized trial was conducted to compare the efficacy and tolerability of imipenem-cilastatin ( I-C ) monotherapy with clindamycin+aminoglycoside ( C+A ) combination therapy .  Forty-nine patients were able to be evaluated for clinical efficacy in the treatment of postpartum endometritis . Twenty-three patients received I-C and 26 received C+A therapy . The two groups were statistically similar for demographic and clinical variables upon entry into the study . The results of therapy were categorized as cured , improved , or failed . The use of I-C result ed in an overall clinical response rate ( cured and improved ) of  
    Output:
    
There was no evidence of difference in incidence of allergic reactions .
Cephalosporins were associated with less diarrhea .
REVIEW ERS ' CONCLUSIONS The combination of gentamicin and clindamycin is appropriate for the treatment of endometritis .
Regimens with activity against penicillin- resistant anaerobic bacteria are better than those without .
There is no evidence that any one regimen is associated with fewer side effects .
Once uncomplicated endometritis has clinical ly improved with intravenous therapy , oral therapy is not needed