A Cochrane review [Abstract] 1 included 95 studies with a total of over 15 000 women. Prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection ( RR 0.40, 95% CI 0.35 to 0.46; 82 studies, n=14 407), endometritis (RR 0.38, 95% CI 0.34 to 0.42; 83 studies, n=13 548) and serious maternal infectious complications (RR 0.31, 95% CI 0.20 to 0.49; 32 studies, n=6159). Similar reductions in the incidence of infections were seen for most of the antibiotics and combinations. No conclusions can be made about other maternal adverse effects or infant adverse outcomes and in particular there was no assessment of infant oral thrush. There was no systematic collection of data on bacterial drug resistance. The findings were similar whether the cesarean section was elective or non elective, and whether the antibiotic was given before or after umbilical cord clamping.
A meta-analysis 2 comparing different penicillin antibiotics for prophylaxis in cesarean section included 18 RCTs involving a total of 3 287 women. There was no significant difference between single dose versus multidose for infections (maternal sepsis, endometritis, fever, urinary tract infection, wound infection, and length of stay; 7 trials, n=1180), neither between short term versus long term (2 trials). 5 studies (n=1018) compared the timing of administration. For sepsis, there was no statistically significant difference between administration before skin incision and after umbilical cord clamping (RR 0.67, 95% CI 0.20 to 2.26, I²= 0%; 2 trials, n=180). Administration before skin incision reduced the rate of endometritis (RR 0.21, 95% CI 0.10 to 0.45, I²=0%; 2 trials, n=406) and wound infection (RR 0.21, 95% CI 0.09 to 0.50, I²= 0%; 3 trials, n=838). 4 studies (n=933) compared the effect of penicillins combine with enzyme inhibitors with penicillins alone: ampicillin (/sulbactam), piperacillin (/tazobactam) and amoxycillin (/clavulanic acid). Combined treatment with an inhibitor probably led to fewer cases of endometritis (RR 0.39, 95% CI 0.21 to 0.72, I²= 0%; 3 trials, n=633) and of maternal febrile morbidity (RR 0.46, 95% CI 0.21-1.00, I²= 0%; 2 trials, n=431). There was no difference in urinary tract infection (RR 1.00, 95% CI 0.20 to 4.88; 1 trials, n=340) and in wound infection (RR 0.78, 95% CI 0.19 to 3.12, I²= 23%; 2 trials, n= 640).
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