Comparative Efficacy of Single-Dose versus Multiple-Dose Antibiotic Prophylaxis in Reducing Postoperative Infections in Elective Cesarean Deliveries
Antibiotic Prophylaxis in Cesarean Deliveries
DOI:
https://doi.org/10.54393/pjhs.v5i09.2060Keywords:
Endometritis, Multiple-Dose, Surgical Site Infections, Cesarean Section, Antibiotic ProphylacticAbstract
Cesarean Sections (CS) were common surgeries that may lead to complications like endometritis and Surgical Site Infections (SSIs). While prophylactic antibiotics reduce these risks, the ideal dosing regimen remains debated. Objective: To evaluates whether a single or multiple-dose antibiotic regimen offers better protection against infections in patients undergoing planned cesarean sections. Methods: A six-month quasi-experimental study was conducted from October 1, 2020, to March 30, 2021, at Lady Reading Hospital in Peshawar. Eighty-two women scheduled for elective CS were assigned into two groups: one received a single 1g dose of intravenous cefazolin before surgery, and the other received the same initial dose followed by two additional doses every eight hours. Primary outcomes assessed were the incidence of endometritis and SSIs within 30 days post-surgery. Results: Postpartum infections were significantly lower in the multiple-dose group (4.9%) compared to the single-dose group (19.5%, p = 0.039). The multiple-dose group also had fewer SSIs (4.9% vs. 14.6%, p = 0.140) and no cases of endometritis (0% vs. 4.9%, p = 0.154), though these differences were not statistically significant. There were no significant differences in adverse drug reactions, hospital stay duration, or antibiotic resistance development between the groups. Conclusions: Multiple-dose antibiotic regimens may reduce infection rates in planned CS without increasing adverse effects or antibiotic resistance. Further studies were needed to confirm these findings and optimize prophylactic strategies.
References
La Rosa M, Omere C, Redfern T, Abdelwahab M, Spencer N, Villarreal J et al. The impact of low-dose versus high-dose antibiotic prophylaxis regimens on surgical site infection rates after cesarean delivery. Archives of Gynecology and Obstetrics. 2020 Jan; 301: 69-73. doi: 10.1007/s00404-019-05370-y. DOI: https://doi.org/10.1007/s00404-019-05370-y
Igwemadu GT, Eleje GU, Eno EE, Akunaeziri UA, Afolabi FA, Alao AI, Ochima O. Single-dose versus multiple-dose antibiotics prophylaxis for preventing caesarean section postpartum infections: A randomized controlled trial. Women's Health. 2022 Jun; 18: 17455057221101071. doi: 10.1177/17455057221101071. DOI: https://doi.org/10.1177/17455057221101071
Adaji JA, Akaba GO, Isah AY, Yunusa T. Short versus long-term antibiotic prophylaxis in cesarean section: A randomized clinical trial. Nigerian Medical Journal. 2020 Jul-Aug; 61(4): 173-9. doi: 10.4103/nmj.NMJ_197_20. DOI: https://doi.org/10.4103/nmj.NMJ_197_20
Mohammed SO, Shuaibu SD, Gaya SA, Rabiu A. The efficacy of two doses versus 7 days' course of prophylactic antibiotics following cesarean section: An experience from Aminu Kano Teaching Hospital. Annals of African Medicine. 2020 Apr; 19(2): 103-12. doi: 10.4103/aam.aam_39_19. DOI: https://doi.org/10.4103/aam.aam_39_19
Jansson MH, Cao Y, Nilsson K, Larsson PG, Hagberg L. Cost-effectiveness of antibiotic prophylaxis in elective cesarean section. Cost Effectiveness and Resource Allocation. 2018 Dec; 16: 1-8. doi: 10.1186/s12962-018-0168-x. DOI: https://doi.org/10.1186/s12962-018-0168-x
Farid M, Asmaa ME, Ibrahim S, Ahmed YE. The Impact of Low Dose versus High Dose Antibiotic Prophylaxis Regimens on Surgical Site Infection Rates after Cesarean Delivery: Randomized Controlled Trial. The Medical Journal of Cairo University. 2023 Mar; 91(03): 283-95. doi: 10.21608/mjcu.2023.307573. DOI: https://doi.org/10.21608/mjcu.2023.307573
Suliman SM, Yousef BA, Hamadelnil AA. Impact of guidelines implementation for the rational use of prophylactic antibiotics in elective cesarean sections at Elqutainah Teaching Hospital. Journal of Family Medicine and Primary Care. 2020 Jan; 9(1): 162-7. doi: 10.4103/jfmpc.jfmpc_903_19. DOI: https://doi.org/10.4103/jfmpc.jfmpc_903_19
Mudanur SR, Kori SS, Biradar A, Yaliwal RG, Biradar DS, Ramdurg S et al. Single vs Multiple Antibiotic Drug Regimen in Preventing Infectious Morbidity in Caesarean Section: A Randomised Clinical Trial. 2021 Jan. doi: 10.7860/JCDR/2021/49372.15103. DOI: https://doi.org/10.7860/JCDR/2021/49372.15103
Jyothi MS, Kalra JK, Arora A, Patil A, Suri V, Jain V et al. Randomized controlled trial of cefazolin monotherapy versus cefazolin plus azithromycin single dose prophylaxis for cesarean deliveries: A developing country's perspective. Journal of Family Medicine and Primary Care. 2019 Sep; 8(9): 3015-21. doi: 10.4103/jfmpc.jfmpc_593_19. DOI: https://doi.org/10.4103/jfmpc.jfmpc_593_19
Kawakita T, Huang CC, Landy HJ. Choice of prophylactic antibiotics and surgical site infections after cesarean delivery. Obstetrics & Gynecology. 2018 Oct; 132(4): 948-55. doi: 10.1097/AOG.0000000000002863. DOI: https://doi.org/10.1097/AOG.0000000000002863
Muzayyanah B, Hasmono D, Wisudani N. Analysis of Prophylactic Antibiotics Usage in Caesarean Section Delivery. Folia Medica Indonesiana. 2018 Sep; 54(3): 161-6. doi: 10.20473/fmi.v54i3.10004. DOI: https://doi.org/10.20473/fmi.v54i3.10004
Kang H. Sample size determination and power analysis using the G* Power software. Journal of Educational Evaluation for Health Professions. 2021 Jul; 1(18): 17. doi: 10.3352/jeehp.2021.18.17. DOI: https://doi.org/10.3352/jeehp.2021.18.17
Reiff ES, Habib AS, Carvalho B, Raghunathan K. Antibiotic prophylaxis for cesarean delivery: a survey of anesthesiologists. Anesthesiology Research and Practice. 2020 Dec; 2020(1): 3741608. doi: 10.1155/2020/3741608. DOI: https://doi.org/10.1155/2020/3741608
Tietel M, Shema-Didi L, Roth R, Wolf MF, Bornstein J. Compliance with a new quality standard regarding administration of prophylactic antibiotics before cesarean section. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Dec; 35(25): 6243-9. doi: 10.1080/14767058.2021.1910659. DOI: https://doi.org/10.1080/14767058.2021.1910659
Sabila NM and Rosa EM. The effectiveness of the use of antibiotics prophylaxis in prevention of surgical site infection in caesarean section. Turkish Journal of Physiotherapy and Rehabilitation. 2014 Oct; 2014(10): CD007482. doi: 10.1002/14651858.CD007482.pub3. DOI: https://doi.org/10.1002/14651858.CD007482.pub3
Hopkins MK, Dotters-Katz S, Boggess K, Heine RP, Smid M. Perioperative antibiotic choice in labored versus unlabored cesareans and risk of postcesarean infectious morbidity. American Journal of Perinatology. 2018 Jan; 35(02): 127-33. doi: 10.1055/s-0037-1606187. DOI: https://doi.org/10.1055/s-0037-1606187
Bassetti M, Russo A, Carnelutti A, La Rosa A, Righi E. Antimicrobial resistance and treatment: an unmet clinical safety need. Expert opinion on drug safety. 2018 Jul; 17(7): 669-80. doi: 10.1080/14740338.2018.1488962. DOI: https://doi.org/10.1080/14740338.2018.1488962
Rubin H, Rom E, Wattad M, Seh K, Levy N, Jehassi A et al. Effectiveness of antimicrobial prophylaxis at 30 versus 60 min before cesarean delivery. Scientific Reports. 2021 Apr; 11(1): 8401. doi: 10.1038/s41598-021-87846-z. DOI: https://doi.org/10.1038/s41598-021-87846-z
Bar-On YM, Goldberg Y, Mandel M, Bodenheimer O, Amir O, Freedman L et al. Protection by a Fourth Dose of BNT162b2 against Omicron in Israel. New England Journal of Medicine. 2022 May; 386(18): 1712-20. doi: 10.1056/NEJMoa2201570. DOI: https://doi.org/10.1056/NEJMoa2201570
Dellapiana G, Levian C, Gubernick L, Burwick RM. Prophylactic postoperative antibiotics after emergent cesarean delivery and risk of postpartum infection or wound complication. The Journal of Maternal-Fetal & Neonatal Medicine. 2022 Dec; 35(25): 6830-5. doi: 10.1080/14767058.2021.1926449. DOI: https://doi.org/10.1080/14767058.2021.1926449
Akkour KM, Arafah MA, Alhulwah MM, Badaghish RS, Alhalal HA, Alayed NM et al. A comparative study between a single-dose and 24-hour multiple-dose antibiotic prophylaxis for elective hysterectomy. The Journal of Infection in Developing Countries. 2020 Nov; 14(11): 1306-13. doi: 10.3855/jidc.13034. DOI: https://doi.org/10.3855/jidc.13034
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Pakistan Journal of Health Sciences (Lahore)
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments