Emerging concepts in antibiotic prophylaxis for cesarean delivery

A systematic review

Alan T N Tita, Dwight J. Rouse, Sean Blackwell, George Saade, Catherine Y. Spong, William W. Andrews

Research output: Contribution to journalArticle

84 Citations (Scopus)

Abstract

OBJECTIVE:: To review the current status of antibiotic prophylaxis for cesarean delivery, emerging strategies to enhance the effectiveness of antibiotic prophylaxis in reducing postcesarean infection, and the implications of the emerging practices. DATA SOURCES:: We conducted a full PubMed (January 1966 to July 2008) search using the key words "cesarean" and "antibiotic prophylaxis." A total of 277 articles were identified and supplemented by a bibliographic search. METHODS OF STUDY SELECTION:: We selected a total of 15 studies, which included all published clinical trials, meta-analyses of clinical trials, and observational studies evaluating either the timing of antibiotics or the use of extended-spectrum prophylaxis. We also reviewed nine reports involving national recommendations or technical reviews supporting current standards for antibiotic prophylaxis. TABULATION, INTEGRATION, AND RESULTS:: We conducted an analytic review and tabulation of selected studies without further meta-analysis. Although current guidelines for antibiotic prophylaxis recommend the administration of narrow-spectrum antibiotics (cefazolin) after clamping of the umbilical cord, the data suggest that antibiotic administration before surgical incision or the use of extended-spectrum regimens (involving azithromycin or metronidazole) after cord clamp may reduce postcesarean maternal infection by up to 50%. However, these two strategies have not been compared with each other. In addition, their effect on neonatal infection or infection with resistant organisms warrants further study. CONCLUSION:: The use of either cefazolin alone before surgical incision or an extended-spectrum regimen after cord clamp seems to be associated with a reduction in postcesarean maternal infection. Confirmatory studies focusing additionally on neonatal outcomes and the effect on resistant organisms, as well as studies comparing both strategies, are needed.

Original languageEnglish (US)
Pages (from-to)675-682
Number of pages8
JournalObstetrics and Gynecology
Volume113
Issue number3
DOIs
StatePublished - Mar 2009
Externally publishedYes

Fingerprint

Antibiotic Prophylaxis
Cefazolin
Infection
Anti-Bacterial Agents
Meta-Analysis
Mothers
Clinical Trials
Azithromycin
Umbilical Cord
Metronidazole
PubMed
Constriction
Observational Studies
Guidelines

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Emerging concepts in antibiotic prophylaxis for cesarean delivery : A systematic review. / Tita, Alan T N; Rouse, Dwight J.; Blackwell, Sean; Saade, George; Spong, Catherine Y.; Andrews, William W.

In: Obstetrics and Gynecology, Vol. 113, No. 3, 03.2009, p. 675-682.

Research output: Contribution to journalArticle

Tita, Alan T N ; Rouse, Dwight J. ; Blackwell, Sean ; Saade, George ; Spong, Catherine Y. ; Andrews, William W. / Emerging concepts in antibiotic prophylaxis for cesarean delivery : A systematic review. In: Obstetrics and Gynecology. 2009 ; Vol. 113, No. 3. pp. 675-682.
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