Abstract
OBJECTIVE: To assess the efficacy of single-dose antibiotic prophylaxis against postpartum endomyometritis in high-risk cesarean section patients. DESIGN: Patients were administered one of three single-dose antibiotic regimens following umbilical cord clamping after cesarean section delivery. SETTING: Prospective randomized trial at a university-based hospital. PATIENTS: The study evaluated 293 consenting women undergoing cesarean section who had either experienced labor for a duration of > or = 6 hr or rupture of amniotic membranes. MAIN OUTCOME MEASURES: Development of postpartum endomyometritis. RESULTS: The incidence of postpartum endomyometritis was 7/95 (7.4%) following the ampicillin/sulbactam regimen, 14/98 (14.3%) after the cefazolin regimen, and 11/99 (11.1%) after the cefotetan regimen. There was no significant difference in postpartum infection among the three study arms. In addition, the incidence of endomyometritis in the three single-dose study arms was not higher than previously noted in studies where three doses of antibiotic were administered. CONCLUSION: Single-dose antibiotic prophylaxis should replace the standard triple-dose therapy for uninfected women undergoing cesarean section who are at risk for postoperative endomyometritis. Ampicillin/sulbactam, cefazolin, and cefotetan are all reasonable antibiotic choices for single-dose therapy.
Full Text
The Full Text of this article is available as a PDF (353.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Benigno B. B., Ford L. C., Lawrence W. D., Ledger W. J., Ling F. W., McNeeley S. G. A double-blind, controlled comparison of piperacillin and cefoxitin in the prevention of postoperative infection in patients undergoing cesarean section. Surg Gynecol Obstet. 1986 Jan;162(1):1–7. [PubMed] [Google Scholar]
- Berkeley A. S., Hirsch J. C., Freedman K. S., Ledger W. J. Cefotaxime for cesarean section prophylaxis in labor. Intravenous administration vs. lavage. J Reprod Med. 1990 Mar;35(3):214–218. [PubMed] [Google Scholar]
- Duff P., Robertson A. W., Read J. A. Single-dose cefazolin versus cefonicid for antibiotic prophylaxis in cesarean delivery. Obstet Gynecol. 1987 Nov;70(5):718–721. [PubMed] [Google Scholar]
- Gassner C. B., Ledger W. J. The relationship of hospital-acquired infection to invasive intrapartum monitoring techniques. Am J Obstet Gynecol. 1976 Sep 1;126(1):33–37. doi: 10.1016/0002-9378(76)90460-9. [DOI] [PubMed] [Google Scholar]
- Lewis D. F., Fontenot M. T., Brooks G. G., Wise R., Perkins M. B., Heymann A. R. Latency period after preterm premature rupture of membranes: a comparison of ampicillin with and without sulbactam. Obstet Gynecol. 1995 Sep;86(3):392–395. doi: 10.1016/0029-7844(95)00181-P. [DOI] [PubMed] [Google Scholar]
- McGregor J. A., Crombleholme W. R., Newton E., Sweet R. L., Tuomala R., Gibbs R. S. Randomized comparison of ampicillin-sulbactam to cefoxitin and doxycycline or clindamycin and gentamicin in the treatment of pelvic inflammatory disease or endometritis. Obstet Gynecol. 1994 Jun;83(6):998–1004. doi: 10.1097/00006250-199406000-00020. [DOI] [PubMed] [Google Scholar]
- McGregor J. A., French J. I., Makowski E. Single-dose cefotetan versus multidose cefoxitin for prophylaxis in cesarean section in high-risk patients. Am J Obstet Gynecol. 1986 Apr;154(4):955–960. doi: 10.1016/0002-9378(86)90497-7. [DOI] [PubMed] [Google Scholar]
- Sweet R. L., Ledger W. J. Puerperal infectious morbidity: a two-year review. Am J Obstet Gynecol. 1973 Dec 15;117(8):1093–1100. doi: 10.1016/0002-9378(73)90759-x. [DOI] [PubMed] [Google Scholar]
- Wong R., Gee C. L., Ledger W. J. Prophylactic use of cefazolin in monitored obstetric patients undergoing cesarean section. Obstet Gynecol. 1978 Apr;51(4):407–411. doi: 10.1097/00006250-197804000-00004. [DOI] [PubMed] [Google Scholar]
- Young R., Platt L., Ledger W. Prophylactic cefoxitin in cesarean section. Surg Gynecol Obstet. 1983 Jul;157(1):11–14. [PubMed] [Google Scholar]