Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2010 Jan 20:(1):CD007482.
doi: 10.1002/14651858.CD007482.pub2.

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Fiona M Smaill  1 , Gillian Ml Gyte
Affiliations
Meta-Analysis

Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section

Fiona M Smaill et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: The single most important risk factor for postpartum maternal infection is cesarean section. Routine prophylaxis with antibiotics may reduce this risk and should be assessed in terms of benefits and harms.

Objectives: To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009).

Selection criteria: Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section.

Data collection and analysis: Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.

Main results: We identified 86 studies involving over 13,000 women. Prophylactic antibiotics in women undergoing cesarean section substantially reduced the incidence of febrile morbidity (average risk ratio (RR) 0.45; 95% confidence interval (CI) 0.39 to 0.51, 50 studies, 8141 women), wound infection (average RR 0.39; 95% CI 0.32 to 0.48, 77 studies, 11,961 women), endometritis (RR 0.38; 95% CI 0.34 to 0.42, 79 studies, 12,142 women) and serious maternal infectious complications (RR 0.31; 95% CI 0.19 to 0.48, 31 studies, 5047 women). No conclusions can be made about other maternal adverse effects from these studies (RR 2.43; 95% CI 1.00 to 5.90, 13 studies, 2131 women). None of the 86 studies reported 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. Overall, the methodological quality of the trials was unclear and in only a few studies was it obvious that potential other sources of bias had been adequately addressed.

Authors' conclusions: Endometritis was reduced by two thirds to three quarters and a decrease in wound infection was also identified. However, there was incomplete information collected about potential adverse effects, including the effect of antibiotics on the baby, making the assessment of overall benefits and harms complicated. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is clearly beneficial for women but there is uncertainty about the consequences for the baby.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Methodological quality graph: review authors’ judgements about each methodological quality item presented as percentages across all included studies
Figure 2
Figure 2. Methodological quality summary: review authors’ judgements about each methodological quality item for each included study
Figure 3
Figure 3. Funnel plot of comparison: 1 Antibiotic prophylaxis versus no antibiotic prophylaxis, outcome: 1.1 Maternal fever/febrile morbidity
Figure 4
Figure 4. Funnel plot of comparison: 1 Antibiotic prophylaxis versus no antibiotic prophylaxis, outcome: 1.2 Maternal wound infection
Figure 5
Figure 5. Funnel plot of comparison: 1 Antibiotic prophylaxis versus no antibiotic prophylaxis, outcome: 1.3 Maternal endometritis
Figure 6
Figure 6. Funnel plot of comparison: 1 Antibiotic prophylaxis versus no antibiotic prophylaxis, outcome: 1.4 Maternal serious infectious complications
Figure 7
Figure 7. Funnel plot of comparison: 1 Antibiotics versus no antibiotics - by type of cesarean section, outcome: 1.1 Maternal fever/febrile morbidity
Figure 8
Figure 8. Funnel plot of comparison: 1 Antibiotics versus no antibiotics - by type of cesarean section, outcome: 1.2 Maternal wound infection
Figure 9
Figure 9. Funnel plot of comparison: 1 Antibiotics versus no antibiotics - by type of cesarean section, outcome: 1.3 Maternal endometritis
Figure 10
Figure 10. Funnel plot of comparison: 1 Antibiotics versus no antibiotics - by type of cesarean section, outcome: 1.4 Maternal serious infectious complications
Figure 11
Figure 11. Funnel plot of comparison: 2 Antibiotics versus no antibiotics - by timing of administration, outcome: 2.1 Maternal fever/febrile morbidity
Figure 12
Figure 12. Funnel plot of comparison: 2 Antibiotics versus no antibiotics - by timing of administration, outcome: 2.2 Maternal wound infection
Figure 13
Figure 13. Funnel plot of comparison: 2 Antibiotics versus no antibiotics - by timing of administration, outcome: 2.3 Maternal endometritis
Figure 14
Figure 14. Funnel plot of comparison: 2 Antibiotics versus no antibiotics - by timing of administration, outcome: 2.4 Maternal serious infectious complications
See this image and copyright information in PMC

References

References to studies included in this review

    1. Adam I, Adam ES, Gerais AS. Randomized trial of ceftriaxone prophylaxis in elective cesarean section. Saudi Medical Journal. 2005;26(3):500–1. [published data only] - PubMed
    1. Adeleye JA, Osinusi BO. The use of prophylactic antibiotics in caesarean sections. Singapore Journal of Obstetrics and Gynaecology. 1981;12:29–34. [published data only]
    1. Allen JL, Rampone JF, Wheeless CR. Use of a prophylactic antibiotic in elective major gynecologic operations. Obstetrics & Gynecology. 1972;39:218–24. [published data only] - PubMed
    1. Appuzzio JJ, Ganesh VV, Pelosi MA, Frisoli G. The effect of prophylactic antibiotics on risk factors for endomyometritis in adolescent patients undergoing cesarean section. Journal of Adolescent Health Care. 1984;5:163–6. [published data only] - PubMed

    1. *

    2. Apuzzio JJ, Reyelt C, Pelosi M, Sen P, Louria DB. Prophylactic antibiotics for cesarean section: comparison of high- and low-risk patients for endomyometritis. Obstetrics and Gynecology. 1982;59:693. [published data only] - PubMed

References to studies excluded from this review

    1. Andrews WW, Hauth JC, Cliver SP, Savage K, Goldenberg RL. Randomized clinical trial of extended spectrum antibiotic prophylaxis with coverage for ureaplasma urealyticum to reduce post-cesarean delivery endometritis. Obstetrics & Gynecology. 2003;101(6):1183–9. [published data only] - PubMed
    1. Cormier Ph, Leng JJ, Janky E, Brouste V, Duthil B. Antibiotic prophylaxis with cefotetan in the prevention of post-partum and post-abortum infectious complications in endo-uterine investigations [Prevention par l’utilization du cefotetan des complications infectieuses du post-partum et du post-abortum dans les manoevres endo-manoeuvres uterines] Revue Francaise de Gynecologie et d Obstetrique. 1988;83:829–32. [published data only] - PubMed
    1. Creatsas G, Pavlatos M, Lolis D, Kaskarelis D. Ampicillin and gentamicin in the treatment of fetal intrauterine infections. Journal of Perinatal Medicine. 1980;8:13–8. [published data only] - PubMed
    1. De Palma RT, Leveno KJ, Cunningham FG, Pope T, Kappus SS, Roark ML, et al. Identification and management of women at high risk for pelvic infection following cesarean section. Obstetrics & Gynecology. 1980;55:185S–192S. [published data only] - PubMed
    1. Elliott JP, Freeman RK, Dorchester W. Short versus long course of prophylactic antibiotics in cesarean section. American Journal of Obstetrics and Gynecology. 1982;143:740–4. [published data only] - PubMed

References to studies awaiting assessment

    1. Ahued Ahued RA, Leal del Rosal JA, Rocha del Valle G, Sereno Colo JA. The efficacy of sulbactam-ampicillin in preventing postoperative infections in gynecology and obstetrics. A comparative open study [Eficacia de sulbactam/ampicilina en la profilaxis de infecciones postquirurgicas en gineco-obstetricia. Estudio abierto comparativo] Ginecologia y Obstetricia de Mexico. 1994;62(9):282–4. [published data only] - PubMed
    1. Battarino O, Battarino A. Short-term antibiotic prophylaxis in cesarean section [La profilassi antibiotica short-time nel taglio cesareo] Minerva Ginecologica. 1988;40:563–7. [published data only] - PubMed
    1. Garcia MH, Garcia I, Doyague MJ, Luna S, Velasco MJ, Lanchares JL, et al. Incidence of urinary infection and other infectious complications in antibiotic prophylaxis of cesaran section with ultra-short schedule. III [Incidencia de infección urinaria y otras complicaciones infecciosas en la profilaxis antibiótica de la cesárea con pauta ultracorta. III] Tokoginecologia Practica. 1992;51(7):349–56.
    1. García MHH, Lajas JA, Velasco MJ, Doyague MJ, Luna S, García A, et al. Incidence of endometritis and infection of surgical wound in antibiotic prophylaxis of cesarean section with ultra-short shedule. II [Incidencia de endometritis e infección en la herida oporatoria en la profilaxis antibiótica de la cesárea con pauta ultracorta. II] Tokoginecologia Practica. 1992;51:340–8. [published data only]
    1. Heilmann L, Tauber PF. Short-term prevention with cefoxitin in cesarean section [Kurzzeitprophylaxe mit Cefoxitin beim Kaiser-schnitt] Geburtshilfe und Frauenheilkunde. 1984;44:792–5. [published data only] - PubMed

Additional references

    1. American College of Obstetricians and Gynecologists ACOG practice bulletin number 47, October 2003: prophylactic antibiotics in labor and delivery. Obstetrics & Gynecology. 2003;102:875–82. - PubMed
    1. Baker C, Luce J, Chenoweth C, Friedman C. Comparison of case-finding methodologies for endometritis after cesarean section. American Journal of Infection Control. 1995;23:27–33. - PubMed
    1. Beattie PG, Rings TR, Hunter MF, Lake Y. Risk factors for wound infection following caesarean section. Australian and New Zealand Journal of Obstetrics and Gynaecology. 1994;34:398–402. - PubMed
    1. Bedford Russell A, Murch S. Could peripartum antibiotics have delayed health consequences for the infant? BJOG: an international journal of obstetrics and gynaecology. 2006;113:758–65. - PubMed
    1. Boggess KA, Watts DH, Hillier SL, Krohn MA, Benedetti TJ, Eschenbach DA. Bacteremia shortly after placental separation during cesarean delivery. Obstetrics & Gynecology. 1996;87:779–84. - PubMed

References to other published versions of this review

    1. Smaill F, The Cochrane Collaboration . Prophylactic antibiotics for elective Caesarean section [revised 06 May 1993] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C, editors. The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] 2. Update Software; Oxford: 1995a. Pregnancy and Childbirth Module.
    1. Smaill F. Prophylactic antibiotics in Caesarean section (all trials) [revised 03 August 1994] In: Enkin MW, Keirse MJNC, Renfrew MJ, Neilson JP, Crowther C, The Cochrane Collaboration, editors. The Cochrane Pregnancy and Childbirth Database [database on disk and CDROM] 2. Update Software; Oxford: 1995b. Pregnancy and Childbirth Module.
    1. Smaill F, Hofmeyr GJ, Smaill FM. Antibiotic prophylaxis for cesarean section. Cochrane Database of Systematic Reviews. 2002;(3) DOI: 10.1002/14651858.CD000933. - PubMed

MeSH terms