Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Abstract

Endometritis was reduced by two thirds to three quarters and a decrease in wound infection was also identified. However, there was incomplete information collected about potential adverse effects, including the effect of antibiotics on the baby, making the assessment of overall benefits and harms complicated. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is clearly beneficial for women but there is uncertainty about the consequences for the baby.

Prophylactic Administration of Cefazolin Prior to Skin Incision versus Antibiotics at Cord Clamping in Preventing Postcesarean Infectious Morbidity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…The potential of antibiotic prophylaxis during cesarean delivery to reduce the number of postpartum maternal infections has been studied in many clinical trials and meta-analyses [5,6,7,8]. It is worth mentioning that a Cochrane review updated by Smaill and Gyte [8] in 2010 concluded that prophylactic antibiotics given to all women undergoing elective or nonelective cesarean section was clearly beneficial.…”

“…It is worth mentioning that a Cochrane review updated by Smaill and Gyte [8] in 2010 concluded that prophylactic antibiotics given to all women undergoing elective or nonelective cesarean section was clearly beneficial. Driven by concerns about the sequelae of fetal antibiotic exposure with preincision administration, for nearly 30 years the standard to prevent postcesarean infection has been the administration of narrow-spectrum antibiotic prophylaxis after delivery of the baby and clamping of the umbilical cord [8,9]. …”

Cesarean delivery

“…They are associated with decrease in incidence of endometritis of 62%, in wound infection of 61%, in fever of 55%, and in serious maternal infectious complications by 69% (10,11). Urinary tract infections (UTI) are also markedly decreased.…”

“…Later-generation (e.g., second or third), or more expensive broad-spectrum agents, do not improve efficacy further (11). A multiple-dose regimen for prophylaxis appears to offer no added benefit over a single-dose regimen (10,11). Systemic (after cord clamping) …”

“…Poor: Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes. versus lavage routes of antibiotic administration seem to have similar efficacy (10,11). If ampicillin or a first-generation cephalosporin has already been given in labor (e.g., for chorioamnionitis), there may be no need for additional prophylactic antibiotics at CD.…”