Summary of findings for the main comparison. Antibiotics versus no antibiotics for preventing infection after cesarean section.
| Antibiotics versus no antibiotics for preventing infection after cesarean section | ||||||
| Population: Women undergoing cesarean section. Settings: Both high‐ and low‐income countries. Intervention: Antibiotic prophylaxis1 | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Antibiotic prophylaxis | |||||
| Maternal wound infection | Low (elective)2 | RR 0.40 (0.35 to 0.46) | 14407 (82 studies) | ⊕⊕⊕⊝ moderate3 | ||
| 68 per 1000 | 27 per 1000 (24 to 31) | |||||
| Median2 | ||||||
| 89 per 1000 | 36 per 1000 (31 to 41) | |||||
| Other (includes emergency)2 | ||||||
| 97 per 1000 | 39 per 1000 (34 to 45) | |||||
| Maternal endometritis | Low (elective)2 | RR 0.38 (0.34 to 0.42) | 13548 (83 studies) | ⊕⊕⊕⊝ moderate3 | ||
| 39 per 1000 | 15 per 1000 (13 to 16) | |||||
| Median2 | ||||||
| 160 per 1000 | 61 per 1000 (54 to 67) | |||||
| Other (includes emergency)2 | ||||||
| 184 per 1000 | 70 per 1000 (63 to 77) | |||||
| Maternal serious infectious complications | 25 per 10004 | 8 per 1000 (5 to 12) | RR 0.31 (0.2 to 0.49) | 6159 (32 studies) | ⊕⊕⊕⊝ moderate5 | |
| Adverse effects on infant | See comment | See comment | Not estimable | 0 (0) | See comment | Infant outcomes were not systematically collected nor reported. 6 |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 All classes of antibiotics, dosing regimens (both before and after clamping of the cord) and routes of administration were included. 2 The low risk baseline value is the mean of the control groups of studies reporting outcomes for elective cesarean sections; the other risk estimate is derived from the remaining studies in the review and includes emergency cesarean sections and studies which did not meet our criteria for elective.The median value from all studies is also reported. 3 In most studies the assessment of bias was judged as unclear. In a third of studies the control group did not receive a placebo and lack of blinding could have influenced the assessment of outcomes. In less than 20% of studies was there an adequate description of sequence generation. 4 The study population baseline risk is the mean value in the control groups from all studies that reported this outcome. 5 There was no consistent approach to the definition of serious infectious complications; in only 32 studies was this outcome reported. 6 No study reported effects of antibiotics on the infant immune system or outcome of oral thrush.