Single dose versus multiple dose of antibiotic prophylaxis in caesarean section: a systematic review and meta‐analysis

Pinto-Lopes, Rui; Sousa‐Pinto, Bernardo; Azevedo, Luís Filipe

doi:10.1111/1471-0528.14373

Cited by 26 publications

(26 citation statements)

References 44 publications

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“…Approximately one-quarter of the antibiotics were prescribed for surgical antibiotic prophylaxis. Several studies have demonstrated that single dose antibiotic prophylaxis is as effective as multiple doses [17,18]. Thus, it is recommended that surgical antibiotic prophylaxis should be discontinued within 24 h of completion of surgery in most cases [19].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey

Abubakar

2020

BMC Infect Dis

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Background: The evaluation of antibiotic use among hospitalized patients is a primary step required to design antibiotic stewardship intervention. There is paucity of data describing antibiotic use in hospitals across Northern Nigeria. This study evaluates the prevalence and indications for antibiotic use among inpatients in three acute care hospitals. Methods: A point-prevalence survey was conducted among patients in the wards before or at 8.00 a.m. on the day of the survey, using the point-prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals protocol. The survey was conducted between April and May 2019. The medical records of the patients were reviewed by a clinical pharmacist with the support of physicians and nurses.Results: Overall, 80.1% (257/321) of the patients used at least one antibiotic on the day of the survey. The prevalence of antibiotic use ranged from 72.9% in obstetrics and gynecology to 94.6% in pediatric medical specialty. Community acquired infections (38.7%) and surgical antibiotic prophylaxis (22.5%) were the most common indications. Surgical antibiotic prophylaxis was used or scheduled to be used for more than a day in all the cases. Metronidazole (30.5%), ciprofloxacin (17.1%), ceftriaxone (16.8%), amoxicillin-clavulanate (12.5%) and gentamicin (11.8%) were the most commonly prescribed antibiotics. Overall, broad spectrum antibiotics represented one-third of all the prescriptions. The change of initial antibiotic prescription was reported in one-third of the patients and the reasons include a switch to oral antibiotic (28.5%), escalation (4.5%) and de-escalation (3.6%). Of the 257 patients with an antibiotic prescription, 6.2% had redundant antibiotic combinations. Conclusion:The prevalence of antibiotic use was high with one in three prescriptions having a broad spectrum antibiotic. Prolonged use of surgical antibiotic prophylaxis and redundant antibiotic combination were observed. Antimicrobial stewardship interventions are recommended in order to reduce the use of antibiotics and promote appropriate antibiotics prescribing.

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Section: Discussionmentioning

confidence: 99%

Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey

Abubakar

2020

BMC Infect Dis

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“…Pinto-Lopes R et al in 2017 in his review article included 16 studies, involving 2695 women and no significant difference was observed between single dose and multiple dose antibiotic prophylaxis in the incidence of postpartum infectious morbidity,endometritis, and wound infection. A trend towards lower risk of urinary tract infection was seen with multiple dosing [16] .…”

Section: Discussionmentioning

confidence: 94%

Review of recommendations on prophylactic antibiotic use in cesarean section-A Review Article

Muthyala¹,

Rohilla²,

Aggarwal³

et al. 2018

JGNB

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The significant rise in Cesarean Section (CS) rates in both developing as well as developed countries mandates a definitive protocol for preoperative preparation, intra-operative surgical principles and postoperative care. Apart from surgical and anesthesia related complications, post-operative infections following a CS can lead to puerperal sepsis, near-miss maternal morbidity and mortality. Post cesarean section infections are likely to become a health and economic burden and their prevention remains a public health priority. One such preventive measure is appropriate and timely use of antibiotics in both elective and emergency cesarean sections. The infections are usually poly-microbial, involving aerobic and anaerobic organisms.Role of antibiotic prophylaxis in CS is clearly demonstrated in various studies, but the dosage and the ideal drug, its timing and frequency still remains debatable and controversy.This article reviews on various studies in the recent past regarding recommendations on prophylactic antibiotic use in cesarean section.

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“…Several studies have shown that there is no significant difference in the incidence of postpartum infectious morbidity between the use of single and multiple doses of PAP [18,[21][22][23][24]. The excessive use of antibiotics, therefore, does not reduce the incidence of SSIs, but could favour the emergence of microbial resistances, increase the risk of adverse reactions and generate unnecessary costs to the institution.…”

Section: Papmentioning

confidence: 99%

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

Viamonte

Tames²,

Correa

et al. 2020

Preprint

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Background Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. Methods A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. Results The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR=2.79, P=0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR=1.33, P=0.649). Also, a significant relationship was found between SSI and patient age (Chisq=8.08, P=0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. Conclusions Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

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Single dose versus multiple dose of antibiotic prophylaxis in caesarean section: a systematic review and meta‐analysis

Abstract: Insufficient evidence of difference between dosage regimens of antibiotic prophylaxis in caesarean section.

Cited by 26 publications

References 44 publications

Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey

Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey

Review of recommendations on prophylactic antibiotic use in cesarean section-A Review Article

Compliance with antibiotic prophylaxis guidelines in caesarean delivery: a retrospective, drug utilization study (indication-prescription type) at an Ecuadorian hospital.

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