Prophylactic ceftizoxime for elective cesarean delivery at Soba Hospital, Sudan
Bashier Osman, Amna Abbas, Mohamed A Ahmed, Magid S Abubaker, Ishag Adam, Bashier Osman, Amna Abbas, Mohamed A Ahmed, Magid S Abubaker, Ishag Adam
Abstract
Background: A prophylactic antibiotic is recommended to reduce infection-related complication following cesarean delivery. There is a current debate on the time of prophylactic antibiotic in cesarean delivery.
Methods: An opened randomized, controlled clinical trial was conducted at Soba hospital, Sudan to investigate the timing (pre-incision or after clamping of the umbilical cord) of ceftizoxime for elective cesarean delivery. The outcome measures were; the incidence of post-cesarean febrile and infection-related morbidity and neonatal outcomes between the two groups.
Results: Hundred -eighty women (90 women in each arm of the study) received intravenous injection of 1 g of ceftizoxime as single dose either at pre-incision or after clamping of the umbilical cord. None of the women in either group had endometritis. One woman in the pre-incision group had chest infection. There was no significant difference in the incidence of wound infection between the two groups, 8 (6.7%) vs. 3 (3.3%); P = 0.2. Two babies in the pre-incision group (P = 0.497) had a low Apgar score (< 8) at 1 min. Similar number of neonate (15 in each arm) was admitted to nursery. There were no significant difference in the neonatal jaundice between the two groups, 5 (5.5%) vs. 4 (4.4%), P = 0.2. There was no perinatal death.
Conclusions: There was no difference in the two regimens (pre-incision or post-clamping of the umbilical cord) of ceftizoxime as prophylactic for elective cesarean delivery.
Trial registration: NCT01347593.
References
- DeFrances CJ, Cullen KA, Kozak LJ. National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data. Vital Health Stat. 2007;13:1–209.
- Gibbs RS. Clinical risk factors for puerperal infection. Obstet Gynecol. 1980;55(Suppl 5):178S–184S.
- Bagratee JS, Moodley J, Kleinschmidt I, Zawilski W. A randomized controlled trial of antibiotic prophylaxis in elective caesarean delivery. BJOG. 2001;108:143–148.
- Hofmeyr GJ, Smaill FM. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev. 2010. p. CD000933.
- Smaill FM, Gyte GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2010. p. CD007482.
- Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992;326:281–286. doi: 10.1002/14651858.CD007482.pub2.
- Smaill F, Hofmeyr GJ. Antibiotic prophylaxis for cesarean section. Cochrane Database Syst Rev. 2002. p. CD000933.
- Tita AT, Rouse DJ, Blackwell S, Saade GR, Spong CY, Andrews WW. Emerging concepts in antibiotic prophylaxis for cesarean delivery: a systematic review. Obstet Gynecol. 2009;113:675–682.
- American College of Obstetricians and Gynecologists. ACOG practice bulletin number 47, October 2003: Prophylactic Antibiotics in Labor and Delivery. Obstet Gynecol. 2003;102(4):875–882.
- Hopkins L, Smaill F. WITHDRAWN: Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2012. p. CD001136.
- Aldridge KE. Comparison of the post-antibiotic effect (PAE) induced by ceftizoxime, ceftriaxone, cefoxitin, ampicillin-sulbactam, and ticarcillin-clavulanate against selected isolates of Bacteroides fragilis and B. thetaiotaomicron. Anaerobe. 2002;8(6):295–299. doi: 10.1016/S1075-9964(03)00024-6.
- Ahmed ET, Mirghani OA, Gerais AS, Adam I. Ceftriaxone versus ampicillin/cloxacillin as antibiotic prophylaxis in elective caesarean section. East Mediterr Health J. 2004;10:277–288.
- Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definition of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13:606–608. doi: 10.1086/646436.
- Doss AE, Davidson JD, Cliver SP, Wetta LA, Andrews WW, Tita AT. Antibiotic prophylaxis for cesarean delivery: survey of maternal-fetal medicine physicians in the U.S. J Matern Fetal Neonatal Med. online.
- Cunningham FG, Leveno KJ, DePalma RT, Roark M, Rosenfeld CR. Perioperative antimicrobials for cesarean delivery: before or after cord clamping? Obstet Gynecol. 1983;62(2):151–154.
- Gordon HR, Phelps D, Blanchard K. Prophylactic cesarean section antibiotics: maternal and neonatal morbidity before or after cord clamping. Obstet Gynecol. 1979;53(2):151–156.
- Kaimal AJ, Zlatnik MG, Cheng YW, Thiet MP, Connatty E, Creedy P, Caughey AB. Effect of a change in policy regarding the timing of prophylactic antibiotics on the rate of postcesarean delivery surgical-site infections. Am J Obstet Gynecol. 2008;199(3):310. e1-5.
- Owens SM, Brozanski BS, Meyn LA, Wiesenfeld HC. Antimicrobial prophylaxis for cesarean delivery before skin incision. Obstet Gynecol. 2009;114:573–579. doi: 10.1097/AOG.0b013e3181b490f1.
- Yildirim G, Gungorduk K, Guven HZ, Aslan H, Celikkol O, Sudolmus S, Ceylan Y. When should we perform prophylactic antibiotics in elective cesarean cases? Arch Gynecol Obstet. 2009;280:13–18. doi: 10.1007/s00404-008-0845-7.
- Yokoe DS, Christiansen CL, Johnson R, Sands KE, Livingston J, Shtatland ES, Platt R. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis. 2001;7:837–841.
- Mitt P, Lang K, Peri A, Maimets M. Surgical-site infections following cesarean section in an Estonian university hospital: postdischarge surveillance and analysis of risk factors. Infect Control Hosp Epidemiol. 2005;26:449–454. doi: 10.1086/502566.
- Couto RC, Pedrosa TM, Nogueira JM, Gomes DL, Neto MF, Rezende NA. Post-discharge surveillance and infection rates in obstetric patients. Int J Gynaecol Obstet. 1998;61:227–231. doi: 10.1016/S0020-7292(98)00047-2.
- OpenEpio-epidemioligic calculator. .
Source: PubMed