van der Linden 1993.

Methods	RCT. Individual women. 2‐arm study, stratified by type of operation, CS or hysterectomy. We only report on women having CS here.
Participants	Inclusion criteria Women undergoing vaginal hysterectomy without cysto/rectocoele repair or secondary CS. Secondary CS is defined as CS performed after onset of labour. N = 83 in CS group. Exclusion criteria Hypersensitivity to any of the study drugs, antibiotic treatment within 48 hours prior to surgery, previously scheduled antibiotic treatment during the post‐operative period of 72 hours or longer, impaired renal function, hepatic dysfunction, haematological and neurological disorders, or the presence of serious underlying disease or infection.
Interventions	Intervention: cephalosporin (B2) combination. Cefuroxime (750 mg) plus metronidazole (500 mg, which gives anaerobic cover). The first dose was given IV at the induction of anaesthesia, followed by the same dose 8 and 16 hours later. In women undergoing CS, medication was started immediately after clamping the umbilical cord. N = 42. Comparison: penicillin (A4) combination. Amoxicillin + clavulanic acid (which gives anaerobic cover). Single dose of 2200 mg IV at the induction of anaesthesia. In women undergoing CS, medication was started immediately after clamping the umbilical cord. N = 41.
Outcomes	UTI; febrile temperature; abdominal wound infection; endometritis and infiltrates at the top of the vaginal vault.
Notes	Dates: 1 August 1988 to 15 December 1989. Setting: Leyenburg Hospital, Netherlands. Subgroups Non‐elective CS. After cord clamping. IV administration. Single and multiple doses. Comparisons: 1 (subgroup 4); 2; 3; 4; 8. "This study was sponsored by Smith Kline and Beecham Pharmaceuticals."
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Women were “randomly allocated to one of two treatment regimes”.
Allocation concealment (selection bias)	Unclear risk	No information provided.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	No information provided.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	No information provided.
Incomplete outcome data (attrition bias) All outcomes	Low risk	16 out of 215 (7.4%) women were excluded from the analysis.
Selective reporting (reporting bias)	Unclear risk	The study protocol was unavailable.
Other bias	High risk	Baseline characteristics were similar on: age and weight. Other possible biases were unclear. The study was sponsored by Smith Kline and Beecham Pharmaceuticals.