Ampicillin/Sulbactam versus Cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study

Abstract

BackgroundThe efficacy and safety of a single dose of ampicillin/sulbactam compared to a single dose of cefuroxime at cord clamp for prevention of post-cesarean infectious morbidity has not been assessed.MethodsWomen scheduled for cesarean delivery were randomized to receive a single dose of either 3 g of ampicillin-sulbactam or 1.5 g of cefuroxime intravenously, after umbilical cord clamping. An evaluation for development of postoperative infections and risk factor analysis was performed.ResultsOne hundred and seventy-six patients (median age 28 yrs, IQR: 24-32) were enrolled in the study during the period July 2004 - July 2005. Eighty-five (48.3%) received cefuroxime prophylaxis and 91 (51.7%) ampicillin/sulbactam. Postoperative infection developed in 5 of 86 (5.9%) patients that received cefuroxime compared to 8 of 91 (8.8%) patients that received ampicillin/sulbactam (p = 0.6). In univariate analyses 6 or more vaginal examinations prior to the operation (p = 0.004), membrane rupture for more than 6 hours (p = 0.08) and blood loss greater than 500 ml (p = 0.018) were associated with developing a postoperative surgical site infection (SSI). In logistic regression having 6 or more vaginal examinations was the most significant risk factor for a postoperative SSI (OR 6.8, 95% CI: 1.4-33.4, p = 0.019). Regular prenatal follow-up was associated with a protective effect (OR 0.04, 95% CI: 0.005-0.36, p = 0.004).ConclusionsAmpicillin/sulbactam was as safe and effective as cefuroxime when administered for the prevention of infections following cesarean delivery.Trial registrationClinicaltrials.gov identifier: NCT01138852

Single Versus Multiple Dose Regimen of Prophylactic Antibiotic in Cesarean Section

“…In a study of Denmark among 32,468 mothers, the overall infectious morbidities was 7.6% in CS when compared to 1.6% in vaginal delivery. 5 And similar results were obtained in the study of Ziogos et al 6 and Shetty et al 7 in which overall infectious morbidities were 7.4% and 7.3% respectively. In our study, there were two cases of thrombophlebitis at IV site in group II but this complication was not seen in group I.…”

“…There were no cases of re-hospitalization on either group during the follow up period. This finding is comparable to study of Kayihura et al 12 in which the mean duration of hospital stay was 3.3 days and 3.6 days respectively in study and control group and the study of Ziogos et al 6 in which the mean duration of hospital stay was four days.…”

Surveillance of post-caesarean surgical site infections in a hospital with limited resources, Cambodia

“…But since the late 1990s, international standards recommend a single-dose prophylaxis regimen [16,17]. The choice of using narrow versus broad spectrum antibiotic regimens is currently discussed [18,19] as well as the best timing for prophylaxis initiation, i.e., after cord clamping or before skin incision [20]. From our experience, we would recommend to (1) avoid using new broad spectrum antibiotics; (2) administer the initial dose immediately after the umbilical cord is clamped; (3) consider reducing the duration of antimicrobial prophylaxis.…”

The Surgical Technique of Caesarean Section: What is Evidence Based?

“…Other studies have evaluated different prophylactic antibiotic regimens and compared single dose antibiotics with extended spectrum coverage. Ampicillin/sulbactam [21], triple antibiotic (ampicillin, gentamicin, and metronidazole) [22], and penicillin and cephalothin [23] were compared with standard cephalosporin prophylaxis. There was no improvement shown in giving an extended spectrum coverage compared to a single drug.…”