Prospective cost analysis of moxalactam versus clindamycin plus gentamicin for endomyometritis after cesarean section

Abstract

The direct and indirect costs associated with either moxalactam or clindamycin plus gentamicin as treatment for endomyometritis after emergent cesarean section were compared in an open, randomized prospective trial of 114 patients. A total of 58 patients were assigned to receive moxalactam, 2 g intravenously (i.v.) every 8 h for 5 doses, followed by 2 g every 12 h and prophylactic vitamin K (10 mg) intramuscularly, and 56 patients were assigned to receive clindamycin (600 mg) i.v. every 6 h plus gentamicin (1.5 mg/kg) i.v. every 8 h. Prothrombin times were measured in moxalactam-treated patients, and patients treated with clindamycin plus gentamicin had urinalyses and blood urea nitrogen and serum creatinine determinations performed before and after treatment. Also, gentamicin levels in serum were determined as clinically indicated. A satisfactory treatment response was defined as the resolution of signs and symptoms of endomyometritis within 3 days of the start of antibiotic therapy. Satisfactory responses were demonstrated in 78% of the moxalactam-treated patients and 84% of patients treated with clindamycin plus gentamicin. Mean hosptial costs for laboratory tests ($30.30 versus $4.53) and mean patient charges for laboratory tests ($76.39 versus $27.81) and medications ($539.45 versus $421.82) were significantly higher in patients treated with clindamycin plus gentamicin (P < 0.05), while mean medication costs to the hospital were greater in the moxalactam group ($255.47 versus $195.68; P < 0.05). However, total patient charges and total hosptial drug-associated costs were not significantly different for the two groups. In this study, moxalactam was similar in efficacy and, despite its higher acquisition costs, was comparable in total hospital costs and patient charges to clindamycin plus gentamicin in treating endomyometritis.