Effectiveness of Single Dose Versus Prolonged Antibiotic Prophylaxis in Elective Caesarean Section

Abstract

Introduction:  Caesarean section rates average greater than 20% in the developed world and make up a similar percentage of hospital deliveries in developing countries. Women undergoing caesarean section have a five to 20 – fold greater risk for infection compared with a vaginal delivery. Infectious complications following caesarean delivery include fever, wound infection, endometritis, bacteremia, urinary tract infections and other serious infections. The use of prophylactic antibiotics reduces the incidence of endometritis by two – thirds to three – quarters, and therefore justified its routine use for all women undergoing caesarean section. While the risk of postoperative infection following caesarean section is higher for emergency deliveries than for elective ones, prophylactic antibiotics have also been shown to reduce both endometritis and wound infection following elective caesarean delivery.

Objective:  The objective of the study was to: Compare the effectiveness of single dose versus routine six doses of injectable antibiotics in preventing postoperative complications in women undergoing elective caesarean section.

Study Design:  Randomized clinical trial.

Setting:  This study was conducted at the Department of Gynecology and Obstetrics, Fatima Memorial Hospital, Lahore.

Duration of Study:  Six months from April 2011 – September 2011.

Results:  In this research, majority of the patients were found between 26 – 30 years of age, in Group – A
69 (43.12%) while in Group – B 74 (46.25%). 47 (29.38%) in Group – A and 44 (27.5%) in Group – b were found b/w 20 – 25 yrs of age while 44 (27.5%) in Group – A and 42 (26.25%) patients were found within 31 – 35 years of age. Mean and standard deviation was recorded as 27.04 ± 0.93 in Group – A and 26.58 ± 0.61 in Group – B. 65.62% (n = 105) in Group – A were found 37 – 39 weeks of gestation while 57.5%
(n = 92) were found in Group – B and 34.38% (n = 55) of Group – A and 42.5% (n = 68) of Group – B were recorded between the gestational age of 39 – 41 weeks. 17 (10.63%) in Group – A and 23 (14.37%) in Group – B had wound infection, P-value was calculated as 0.31, while endometritis was found in 14 (8.75%) in Group – A and 27 (16.87%) in Group – B and P-value was recorded as 0.03, while in 129 (80.62%) in Group – A and 110 (68.76%) in Group –
B had no complication.

Conclusion:  Prolonged antibiotic therapy in women undergoing elective caesarean section has no effect with regards to reduce the post operative wound infection and endometritis as compare to single dose therapy.

Key Words:  Caesarean section, post operative complications, wound infection, endometritis, single dose, multiple doses.