In Reply

We thank our colleagues for their comments. They address a specific situation within perioperative antibiotic prophylaxis (PAP)—namely, the benefit and potential harm of antibiotic administration for the mother and baby in the context of a cesarean section. The benefit of PAP in this setting is well documented for the mother; a Cochrane review analyzed the benefit of PAP during cesarean section on the basis of 95 randomized controlled trials (1). Preoperative antibiotic prophylaxis resulted in a reduction of episodes of fever, endometritis, wound infection, urinary tract infection, and severe infections. For this reason, PAP during cesarean section has an evidence based recommendation in the 2020 S3 guideline (2). Nevertheless, the harm of administering antibiotics for the baby’s microbiome must be considered. This requires careful evaluation. The substances most commonly used in studies for PAP in cesarean section are first generation or second generation cephalosporins (cefazolin or cefuroxime). According to a 2020 review article, these substances have a negligible potential for affecting the microbiome negatively (3). This is particularly the case if the modalities of PAP are correctly adhered to and they are administered once only. Administration of amoxicillin with or without clavulanic acid, by contrast, can lead to notable alterations of the microbiome and should therefore be avoided (3). These facts should be described and agreed with patients when giving PAP before an elective cesarean section. This is an integral component of modern individualized antibiotic prophylaxis, which we described in our article (4).