Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity

Abstract

Background: Puerperal sepsis is frequently in Caesarean section. Antibiotic prophylaxis may have significant impact in reduction of infections and thus the need to study its role in sepsis prevention systematically. Objective: The aim of this study is to compare the efficacy of single dose versus multiple doses of a first generation cephalosporin (with Metronidazole), to reduce postoperative infectious morbidity in elective caesarean section. Materials and methods: It was prospective clinical trial of hundred women undergoing elective caesarean section who received either a single prophylactic dose of Cefazolin with Metronidazole post-cord clamping, or multiple postoperative doses of antibiotics based on the standard protocol of the hospital. Duration of the study was seven months and twentytwo days (11th November 2004 to 30th June 2005).Women were compared on the basis of development of postoperative febrile morbidity, endometritis, urinary tract infection, wound infection and other infections. Results: There were no significant differences among the patients in single and multiple dose groups in terms of their age distribution, gravida, period of gestation, smoking status, body mass index, indications for elective caesarean section or operation characteristics. There were 4% and 6% febrile morbidity, 2 (4%) and 0 (0%) urinary tract infection, in the single dose and multiple dose groups respectively. But none of the differences were statistically significant. Conclusion: A single prophylactic dose of Cefazolin plus Metronidazole given post-umbilical cord clamping gives as much protection as multiple postoperative doses of Cefazolin/Cefalexin plus Metronidazole in preventing postoperative infectious morbidity in elective caesarean section. Key words: Antibiotic prophylaxis; Caesarean section DOI: 10.3126/kumj.v8i2.3554 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 179-184

Single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean infection at Bugando Medical Centre in Mwanza, Tanzania: a randomized, equivalence, controlled trial

“…The administration of pre-operative single dose antibiotic prophylaxis has shown to have lower cumulative incidence of surgical-site infection compared to multiple doses. Previous studies have reported that there is no added benefit of using multiples doses over single dose of antibiotics for prophylaxis of SSI [23,33]. For this reason the administration of pre-operative single dose antibiotic prophylaxis for emergency caesarean is recommendable.…”

“…In a systematic review, Owens et al reported that provision of antibiotic prophylaxis for caesarean section before skin incision compared with after umbilical cord clamping is associated with a 40% decrease in postpartum endometritis and a 30% decrease in wound infection [22]. Provision of a single dose of antibiotics preoperatively has been found to be as effective as multiple doses in prevention of postpartum infection [23-25]. …”

Single dose antibiotic prophylaxis in elective obstetric and gynaecological surgeries-a descriptive study

“…Prior to this, prophylactic agents were administered preoperatively. 28 This abrupt change in practice followed the publication of prospective randomized placebo controlled trial demonstrating that prophylactic ampicillin administered after the umbilical cord was clamped was as effective in decreasing maternal morbidity as ampicillin given before to the procedure. At the time of hysterectomy, vaginal or cervical bacteria are inoculated into the surgical site, and it is hypothesized that antimicrobial agent in these tissues at that time augment host defence mechanisms to reduce the incidence of clinical infections.…”

Efficacy of single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean infection: study protocol for a randomized controlled trial

“…Provision of a single dose of antibiotics preoperatively has been found to be as effective as multiple doses, in prevention of postpartum infection [28,29]. …”