Prophylactic Antibiotic during Caesarean Sections at Komfo Anokye Teaching Hospital, Kumasi

Abstract

Summary objectives: To compare the efficacy of co-amoxiclav (amoxicillin + clavulanic acid) and the triple therapy of ampicillin + gentamycin + metronidazole as prophylactic antibiotic during Caesarean sections.

Design: A randomized controlled trial.

Setting: The study was conducted between March and December 2002 at Komfo Anokye Teaching Hospital, Kumasi.

Participants: Patients undergoing caesarean section were recruited into the study and given either drug as prophylaxis. Excluded were patients who had established infections prior to the operation, had had any antibiotic in the preceding 24 hours and those allergic to any of the trial drugs.

Interventions: A total of 320 patients were recruited and randomized on a one-to-one basis into two groups, 160 receiving co-amoxiclav whilst the other 160 received the triple therapy. In either case the drug was given as a single intravenous dose after cord clamping and repeated 12 hours later. No other antibiotic was given except in cases where frank infection was apparent post-operatively.

Outcome measures: Included abdominal wound infection, cough, dysuria, fever, uterine tenderness and offensive lochia after surgery.

Results: Abdominal wound infection was found in rates lower than in a previous study: 3.7% in the co-amoxiclav group and 13.1% in the triple therapy group as against 15.1% in the previous study. Co-amoxiclav was statistically found superior to the Triple Therapy in preventing abdominal wound infection and uterine tenderness. There was however, no statistical difference between the two groups as far as the prevention of cough, dysuria and fever were concerned.

Conclusion: Co-amoxiclav was found to be a better prophylactic antibiotic.

Keywords: Caesarean section; co-amoxiclav; post-partum morbidity; prophylaxis; triple therapy.