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Prophylactic antibiotics with cesarean section 

Prophylactic antibiotics with cesarean section
Chapter:
Prophylactic antibiotics with cesarean section
Author(s):

Murray Enkin

, Marc J. N. C. Keirse

, James Neilson

, Caroline Crowther

, Lelia Duley

, Ellen Hodnett

, and Justus Hofmeyr

DOI:
10.1093/med/9780192631732.003.0043
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date: 23 August 2019

Antibiotic prophylaxis can reduce the risk of serious infections. If the level of post-cesarean infectious morbidity is very low without a policy of antibiotic prophylaxis, the ratio of benefits to costs, in absolute terms, might argue against instituting such a policy. Such circumstances are rare, and the evidence justifies far wider adoption of antibiotic prophylaxis than currently exists. Although the incidence of adverse drug effects among women receiving prophylactic antibiotics has probably been underestimated, it is inconceivable that it could outweigh the reduction in serious maternal morbidity that can be achieved by a policy of antibiotic prophylaxis. Potential adverse drug effects in the baby may be lessened by beginning prophylaxis after the umbilical cord has been divided. The risk of adverse ecological effects is likely to be reduced if the total load of antibiotics is reduced. The disadvantages of longer courses of antibiotics, in terms of an increase in the total antibiotic load and in the number of women experiencing side effects, and the additional financial cost, may outweigh the advantages of greater prophylactic efficacy compared with shorter or single-dose regimens. In regard to choice of antibiotic, the broad-spectrum penicillins are as effective as the cephalosporins. No strong case for using a secondor third-generation cephalosporin, or adding aminoglycosides to broad-spectrum penicillins, can be made.

Withholding prophylactic antibiotics from women having cesarean section will increase the chances that they will experience serious morbidity. Further trials which include no-treatment controls would be unethical.

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