to Pregnancy Reviews
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% (9).
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
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 (11).
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 (12).
This is reflected in the more recent trials (13, 14,15),
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 (15).
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
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