Prophylactic ceftizoxime for elective cesarean delivery at Soba Hospital, Sudan

Abstract

BackgroundA prophylactic antibiotic is recommended to reduce infection-related complication following cesarean delivery. There is a current debate on the time of prophylactic antibiotic in cesarean delivery.MethodsAn opened randomized, controlled clinical trial was conducted at Soba hospital, Sudan to investigate the timing (pre-incision or after clamping of the umbilical cord) of ceftizoxime for elective cesarean delivery. The outcome measures were; the incidence of post-cesarean febrile and infection-related morbidity and neonatal outcomes between the two groups.ResultsHundred –eighty women (90 women in each arm of the study) received intravenous injection of 1 g of ceftizoxime as single dose either at pre-incision or after clamping of the umbilical cord. None of the women in either group had endometritis. One woman in the pre-incision group had chest infection. There was no significant difference in the incidence of wound infection between the two groups, 8 (6.7%) vs. 3 (3.3%); P = 0.2. Two babies in the pre-incision group (P = 0.497) had a low Apgar score (< 8) at 1 min. Similar number of neonate (15 in each arm) was admitted to nursery. There were no significant difference in the neonatal jaundice between the two groups, 5 (5.5%) vs. 4 (4.4%), P = 0.2. There was no perinatal death.ConclusionsThere was no difference in the two regimens (pre-incision or post-clamping of the umbilical cord) of ceftizoxime as prophylactic for elective cesarean delivery.Trial registrationNCT01347593

Prophylactic antibiotics before cord clamping in cesarean delivery: a systematic review

“…We included 18 RCTs comparing the application of prophylactic antibiotics before vs. after cord clamping (13,(17)(18)(19)(20)(21)(22)(23)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). The studies were conducted in the USA (17,20,29,(32)(33)(34)(35), Turkey (37), Austria (36), India (28,30), Iran (18,21), Egypt (31), Tunisia (19), Sudan (22), Italy (23) and China (13). The indication for the cesarean section, number of randomized women in treatment groups, antibiotic class, agent and dosing scheme of the administered antibiotic(s) and the actual time when the antibiotic(s) were given, are presented in Table S1.…”

“…The indication for the cesarean section, number of randomized women in treatment groups, antibiotic class, agent and dosing scheme of the administered antibiotic(s) and the actual time when the antibiotic(s) were given, are presented in Table S1. In brief, 13 studies included women with elective cesarean section solely (13,(17)(18)(19)(20)22,(29)(30)(31)(32)(33)36,37), two studies reported that more than 75% of women received elective cesarean section (21,28), and three studies were focused on non-elective cesarean section (23,34,35). The majority of studies administered a first-generation cephalosporin (cefazolin 1 g, cefazolin 2 g or cefathiamidin 2 g) (13,18,19,21,29,(31)(32)(33)(34)(35)(36)(37).…”

“…Maternal outcomes were investigated in 15 studies including 6841 women (18)(19)(20)22,23,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). There were significant reductions in composite infectious morbidity (as defined by study authors) for women who received antibiotics preoperatively as compared with those who received antibiotics after cord clamping (RR 0.72, 95% CI 0.56-0.92, nine studies, 4342 women, high quality of evidence) ( Figure 2a, Table 1).…”

“…Neonatal outcomes were reported in 13 studies (13,17,19,21,22,(28)(29)(30)(32)(33)(34)(35)37). There were no significant differences in risk for sepsis (RR 0.77, 95% CI 0.52-1.13, eight studies, 3690 newborns, moderate quality of evidence) (Figure 3a, Table 2), sepsis workup (RR 0.90, 95% CI 0.70-1.17, seven studies, 2069 newborns, moderate quality of evidence) (Figure 3b, Table 2), infection with an antibiotic-resistant bacterium (RR 0.70, 95% CI 0.12-4.14; two studies, 813 newborns, low quality of evidence) (Figure 3c, Table 2), neonatal antibiotic treatment (RR 0.68, 95% CI 0.21-2.16, two studies, 872 newborns, moderate quality of evidence) ( Figure 3d, Table 2), fever (RR 0.67, 95% CI 0.28-1.62, one study, 953 newborns, low quality of evidence) ( Figure 3e, Table 2) and ICU admission (RR 0.89, 95% CI 0.74-1.08, 11 studies, 5294 newborns, moderate quality of evidence) ( Figure 3f, Table 2).…”

“…about random sequence generation and allocation concealment (13,22,(28)(29)(30)(31)33,(35)(36)(37). Adequate blinding of study participants and personal and/or outcome assessor was reported in 12 trials.…”