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Are prophylactic antibiotics justified?

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Time to Delivery
Sentinel Audit
Prophylactic antibiotics

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A recognised complication of the caesarean section is wound infections. Most units around the country have a protocol involving prophylactic antibiotics, although the type of antibiotic varies immensely. Literature on this varies, with infectious morbidity rates quoted from 18 -83% (Reference9). Ampicillin and cephalosporins appear to have the same efficacy in reducing post-operative endometritis with no evidence to show that using a more broad - spectrum agent or multiple dose regimes is more efficacious (Reference10). Many studies use Cefuroxime because of its long half-life (1.7hrs) and suitability then for a single dose regime.

The Cochrane database quotes a reduction in endometritis by 75% when using prophylactic antibiotics (Reference11). Analysing this further, the data is based on 7 trials with a total of 875 women. Although infectious morbidity is significantly reduced, wound infection is not. In fact the largest study, of 232 women, shows NO reduction in morbidity (Reference12). This is reflected in the more recent trials (Reference13, Reference14,Reference15), the largest of which is from South Africa. They recruited 480 women into a double blind RCT with reported wound infection rates of 13 v 12% depending on usage, or non-usage of antibiotics (Reference15). It should be reiterated that the above data is based on elective sections only. It leaves us with the question of whether we should be using prophylactic antibiotics at elective sections routinely or whether we should be targeting those that we think are at a higher risk?


9. Enkin M. Antibiotic and cesarean section. IN:ChalmersI, Endin M,Keirse MJNC,editors. Effective care in pregnancy and childbirth. Oxford: Oxford University Press, 1994:322-7.
10. Chapman SJ. Randomized trial of single-dose versus multiple-dose cefotetan for the postpartum treatment of intrapartum chorioamnionitis, Abstract
11. Smaill F. Antibiotic prophylaxis in caesarean section. Cochrane Pregnancy and Childbirth Database, 2000:Issue 2, Abstract
12. Mahomed K. A double blind randomised controlled trial on the use of prophylactic antibiotics in women undergoing elective caesarean section. Br J Obstet Gynaecol 1988;95:689-92, Abstract
13. Yip SK. A study on prophylactic antibiotics in caesarean sections - is it worthwhile? Acta Obstet Gynecol Scand 1997;76:547-9, Abstract
14. Rizk DEE. Systemic antibiotic prophylaxis in elective caesarean delivery. Int J Gynecol Obstet 1998;61:245-51, Abstract
15. Bagratee JS. A randomised controlled trial of antibiotic prophylaxis in elective caesarean delivery. Br J Obstet Gynaecol 2001;108:143-8, Abstract

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