A randomized clinical trial evaluating prophylactic single-dose vs prolonged course of antibiotics for caesarean section in a high HIV-prevalence setting

Abstract

The evidence that perioperative antibiotics for caesarean delivery are effective in reducing infective morbidity is unequivocal. In developing countries, especially those with high HIV-prevalence, clinicians have increasingly become anxious about the efficacy of perioperative antibiotics, hence the adoption of treatment regimens, as described in this study. We set out to investigate if these fears have a basis by conducting a randomised clinical trial. The setting was two tertiary units in a developing country with a significant HIV-prevalence. The outcome measures assessed were: pyrexia, wound infection, admission with puerperal sepsis, laparotomy for pelvic abscess and duration of hospital stay. There was no statistically significant difference between the two arms of the study with regard to the above outcomes. Our conclusion is that the two antibiotic regimens are equivalent in preventing infection, therefore there is no justification for subjecting patients to week-long antibiotics and the unnecessary increase in nurse workload.

State of the art: Intrapartum antibiotics in cesarean section, the infant microbiota and allergic diseases

“…These guidelines are consistent with the most recent recommendations from the World Health Organization as well as current protocols in the United States, Canada and the United Kingdom 2,17,19,25 . Elsewhere, protocols vary to different degrees 26–34 . Implementation of World Health Organization recommendations has been shown to vary widely between countries 35,36 .…”

“…2 , 17 , 19 , 25 Elsewhere, protocols vary to different degrees. 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 Implementation of World Health Organization recommendations has been shown to vary widely between countries. 35 , 36 Whilst Australia and other developed countries may have standardized protocols, varying levels of adherence to these protocols have been reported.…”

Caesarean section wound infections and antibiotic use: a retrospective case-series in a tertiary referral hospital in The Gambia

“…There is conclusive evidence that preoperative antibiotics greatly reduce infectious morbidity 24 and that a single dose is much more effective than multiple doses in the postoperative period. 25 Prophylaxis with a single broad-spectrum antibiotic is usually adequate, 7,23,24,25 and surgical guidelines advise that this should be given within 60 min before incision or sometimes just before the cord is clamped and not repeated. 13 If the operation is complicated, or if signs of infection are blatant, a course of antibiotics is indicated as treatment rather than prophylaxis.…”

“…Further benefits from changing from multiple- to single-dose prophylaxis include mitigation of non-compliance, reduction in staff workload, the conservation of antibiotic resources and reduction in costs. 23,24,25 Additionally, minimising the overuse of antibiotics, and therefore the risk of colonisation by resistant organisms, is another convincing argument for the implementation of single-dose prophylaxis. 23,24,25…”