The efficacy of two doses versus 7 days' course of prophylactic antibiotics following cesarean section: An experience from Aminu Kano Teaching Hospital

Abstract

Background: Postcesarean wound infection is a leading cause of prolonged hospital stay. Considerable debates still exist regarding choice of antibiotics, dose, and duration of use. Objectives: The objective is to compare the efficacy of 2 doses of amoxicillin-clavulanic acid versus a 7 days combination of amoxicillin-clavulanic acid and metronidazole as prophylactic antibiotics following cesarean section (CS). Methodology: It was a randomized controlled trial that was conducted among 160 women undergoing CS at Aminu Kano Teaching Hospital. Women were randomized into two groups. Group I (study group) received 2 doses of 1.2 g amoxicillin-clavulanic acid. Group II (control group) received a 7 days course of amoxicillin-clavulanic acid and metronidazole. The data obtained were analyzed using SPSS version 17. Categorical (qualitative) variables were analyzed using Ch-square test and Fisher’s exact test as appropriate while continuous (quantitative) variables were analyzed using independent sample t -test. P < 0.05 was considered statistically significant. Results: There was no statistically significant association in the occurrence of fever (12.8% vs. 15.8%, P = 0.6), wound infection (6.4% vs. 10.5%, P = 0.36), endometritis (7.7% vs. 11.8%, P = 0.38), UTI (6.4% vs. 5.3%, P = 1.00), mean duration of hospital stay (129.7 vs. 134.2 h, P = 0.48), and neonatal outcomes between the two groups. There was statistically significant difference in the mean cost of antibiotics (₦2883/US$9.5 vs. ₦7040/US$23.1, P < 0.001) and maternal side effects (10.3% vs. 26.3%, P < 0.001) between the study and the control groups, respectively. Conclusion: This study found no statistically significant difference in infectious morbidity, duration of hospital stay, and neonatal outcomes when two doses of amoxicillin-clavulanic acid was compared with a 7 days course of prophylactic antibiotic following CS. The use of two doses of amoxicillin-clavulanic acid has the advantages of reduced cost and some maternal side effects. The two doses were cheaper with minimal side effects.

Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review

“…Otherwise checkup at 2 weeks for SSI evaluation. 1 study had patients provided with at-home thermometer [31,32,39,[41][42][43].…”

Health Systems Interventions for Prevention of Maternal Peripartum Infection in Low and Middle Income Countries: A Systematic Review

“…The studies covered a wide geographical area with a majority in inpatient settings. Seven studies were conducted in Egypt [15,24,25,26,27,28,29], ve studies in India [12,14,30,31,32], four studies in Nigeria [33,34,35,36], three studies in Tanzania [8, 37,38,39], two studies each in Sudan [40,41], Uganda [13,42] and Bangladesh [30,43]. While one study each in South Africa [44], Gambia [46], Malawi [47] and Iran [48].…”

“…Of the 17 RCTs (Table 2) assessed by using RoB2 all the 17 (100%) were considered low risk. Notably three studies [34,47,42] had some concerns of bias due to randomization process. The ROBINS-I tool was used to assess the risk of bias in non RCTs in 11 non-RCT (Table 3).…”

“…In this opened RCT study, 90 women received intravenous 1 gm of ceftizoxime either pre incision or after clamping of the umbilical cord and the authors found no difference in the two timings of antibiotic use. We identi ed ve studies [31,34,35,36,39] that evaluated the duration of antibiotic prophylaxis. These studies supported single and not multiple or prolonged doses.…”

“…The largest number of studies identi ed were on antibiotic prophylaxis for women undergoing Cesarean Section (CS). Ten studies [12,31,34,35,36,39,40,42,44,45] with a total of 3753 women for CS while one study [46] focused on 829 women during labour. The studies were all randomized control covering mainly African countries (n = 9) and South Asia (n = 2).…”