Tully 1983.

Methods	Randomized, placebo‐controlled trial; 2 parallel groups. Unit of randomization: individual placebo‐controlled; double‐blind.
Participants	Dates of data collection: September 1978 to June 1980. Setting: Beth Israel Hospital, Boston, Massachusetts, US. Inclusion criteria: women undergoing primary CS (inclusion criteria not consistent with the definition of non‐elective CS used in this review). N = 113. Exclusion criteria: < 18 years of age, membranes ruptured > 35 hrs, allergy to penicillin or cephalosporin, fever, infection or antibiotic use, significant underlying cardiac, renal or hepatic disease, unable to provide consent.
Interventions	Intervention: cefamycin: cefoxitin 2 g IV immediately after the cord was clamped and at 4 and 8 hrs; N = 52. Comparison: placebo: matched placebo (mannitol with riboflavin); N = 61.
Outcomes	Febrile morbidity (oral temperature > 37.9oC twice at least 6 hrs apart after 1st 24 hrs); UTI (positive culture); wound infection (purulence, cellulitis or dehiscence); endometritis (fever, uterine tenderness, abnormal lochia); septicemia (positive blood culture in a clinically septic patient); additional antibiotic use (8 in treatment group vs 12 in placebo).
Notes	Both episodes of septicemia occurred in the placebo group. Class of antibiotic: cefamycin (2nd generation cephalosporin). Subgroups: type of CS unclear; after cord clamping. The 2 groups were comparable regarding age, BMI, gravidity, frequency of fetal monitoring, number of vaginal examinations, duration of labor, duration of ruptured membranes, duration of surgery and indications for CS.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Comment: randomized as determined by table of random numbers.
Allocation concealment (selection bias)	Low risk	Comment: sequential study numbers.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No loss to follow‐up reported; 14 women (7 in each group) initially randomized were later excluded (all doses not administered, antibiotic therapy prior to surgery, antibiotic following surgery, incorrect dose schedule, infection prior to surgery, drug code broken for possible allergy. As‐treated analysis performed.
Selective reporting (reporting bias)	Unclear risk	Comment: insufficient information to judge.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Comment: randomization was blind to both patients and investigators. Placebo‐controlled (mannitol with riboflavin).
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: insufficient information to judge.
Other bias	Low risk	Comment: no other sources of bias identified.