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Meta-Analysis
. 2014 Nov 17;2014(11):CD008726.
doi: 10.1002/14651858.CD008726.pub2.

Different classes of antibiotics given to women routinely for preventing infection at caesarean section

Gillian M I Gyte  1 , Lixia Dou, Juan C Vazquez
Affiliations
Meta-Analysis

Different classes of antibiotics given to women routinely for preventing infection at caesarean section

Gillian M I Gyte et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Caesarean section increases the risk of postpartum infection for women and prophylactic antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of antibiotics to use and those with the least adverse effects.

Objectives: To determine, from the best available evidence, the balance of benefits and harms between different classes of antibiotic given prophylactically to women undergoing caesarean section.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014) and reference lists of retrieved papers.

Selection criteria: We included randomised controlled trials comparing different classes of prophylactic antibiotics given to women undergoing caesarean section. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane reviews.

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

Main results: We included 35 studies of which 31 provided data on 7697 women. For the main comparison between cephalosporins versus penicillins, there were 30 studies of which 27 provided data on 7299 women. There was a lack of good quality data and important outcomes often included only small numbers of women.For the comparison of a single cephalosporin versus a single penicillin (Comparison 1 subgroup 1), we found no significant difference between these classes of antibiotics for our chosen most important seven outcomes namely: maternal sepsis - there were no women with sepsis in the two studies involving 346 women; maternal endometritis (risk ratio (RR) 1.11, 95% confidence interval (CI) 0.81 to 1.52, nine studies, 3130 women, random effects, moderate quality of the evidence); maternal wound infection (RR 0.83, 95% CI 0.38 to 1.81, nine studies, 1497 women, random effects, low quality of the evidence), maternal urinary tract infection (RR 1.48, 95% CI 0.89 to 2.48, seven studies, 1120 women, low quality of the evidence) and maternal composite adverse effects (RR 2.02, 95% CI 0.18 to 21.96, three studies, 1902 women, very low quality of the evidence). None of the included studies looked for infant sepsis nor infant oral thrush.This meant we could only conclude that the current evidence shows no overall difference between the different classes of antibiotics in terms of reducing maternal infections after caesarean sections. However, none of the studies reported on infections diagnosed after the initial postoperative hospital stay. We were unable to assess what impact, if any, the use of different classes of antibiotics might have on bacterial resistance.

Authors' conclusions: Based on the best currently available evidence, cephalosporins and penicillins have similar efficacy at caesarean section when considering immediate postoperative infections. We have no data for outcomes on the baby, nor on late infections (up to 30 days) in the mother. Clinicians need to consider bacterial resistance and women's individual circumstances.

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Conflict of interest statement

None known.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
2
2
Funnel plot of comparison: 1 Cephalosporins versus penicillins ‐ all women, outcome: 1.2 Maternal endometritis.
3
3
Funnel plot of comparison: 1 Cephalosporins versus penicillins ‐ all women, outcome: 1.7 Maternal urinary tract infection.
4
4
Funnel plot of comparison: 1 Cephalosporins versus penicillins ‐ all women, outcome: 1.5 Maternal fever (febrile morbidity).
5
5
Funnel plot of comparison: 1 Cephalosporins versus penicillins ‐ all women, outcome: 1.6 Maternal wound infection.
1.1
1.1. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 1 Maternal sepsis.
1.2
1.2. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 2 Maternal endometritis.
1.5
1.5. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 5 Maternal fever (febrile morbidity).
1.6
1.6. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 6 Maternal wound infection.
1.7
1.7. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 7 Maternal urinary tract infection.
1.9
1.9. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 9 Maternal composite serious infectious complication.
1.10
1.10. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 10 Maternal composite adverse effects.
1.11
1.11. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 11 Maternal allergic reactions.
1.12
1.12. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 12 Maternal nausea.
1.13
1.13. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 13 Maternal vomiting.
1.14
1.14. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 14 Maternal diarrhoea.
1.15
1.15. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 15 Maternal skin rash.
1.21
1.21. Analysis
Comparison 1 Cephalosporins versus penicillins ‐ all women, Outcome 21 Maternal length of hospital stay.
2.1
2.1. Analysis
Comparison 2 Cephalosporins versus penicillins ‐ by type of caesarean, Outcome 1 Maternal sepsis.
2.2
2.2. Analysis
Comparison 2 Cephalosporins versus penicillins ‐ by type of caesarean, Outcome 2 Maternal endometritis.
3.1
3.1. Analysis
Comparison 3 Cephalosporins versus penicillins ‐ by timing of administration, Outcome 1 Maternal sepsis.
3.2
3.2. Analysis
Comparison 3 Cephalosporins versus penicillins ‐ by timing of administration, Outcome 2 Maternal endometritis.
4.1
4.1. Analysis
Comparison 4 Cephalosporins versus penicillins ‐ by route of administration, Outcome 1 Maternal sepsis.
4.2
4.2. Analysis
Comparison 4 Cephalosporins versus penicillins ‐ by route of administration, Outcome 2 Maternal endometritis.
5.2
5.2. Analysis
Comparison 5 Cephalosporin (1st generation B1) versus penicillins (extended spectrum A3), Outcome 2 Maternal endometritis.
5.5
5.5. Analysis
Comparison 5 Cephalosporin (1st generation B1) versus penicillins (extended spectrum A3), Outcome 5 Maternal fever (febrile morbidity).
5.6
5.6. Analysis
Comparison 5 Cephalosporin (1st generation B1) versus penicillins (extended spectrum A3), Outcome 6 Maternal wound infection.
5.10
5.10. Analysis
Comparison 5 Cephalosporin (1st generation B1) versus penicillins (extended spectrum A3), Outcome 10 Maternal composite adverse effects.
6.2
6.2. Analysis
Comparison 6  Cephalosporin (1st generation B1) versus penicillins  (ampicillin A4), Outcome 2 Maternal endometritis.
6.5
6.5. Analysis
Comparison 6  Cephalosporin (1st generation B1) versus penicillins  (ampicillin A4), Outcome 5 Maternal fever (febrile morbidity).
6.6
6.6. Analysis
Comparison 6  Cephalosporin (1st generation B1) versus penicillins  (ampicillin A4), Outcome 6 Maternal wound infection.
6.7
6.7. Analysis
Comparison 6  Cephalosporin (1st generation B1) versus penicillins  (ampicillin A4), Outcome 7 Maternal urinary tract infection.
6.10
6.10. Analysis
Comparison 6  Cephalosporin (1st generation B1) versus penicillins  (ampicillin A4), Outcome 10 Maternal composite adverse effects.
6.11
6.11. Analysis
Comparison 6  Cephalosporin (1st generation B1) versus penicillins  (ampicillin A4), Outcome 11 Maternal allergic reactions.
6.15
6.15. Analysis
Comparison 6  Cephalosporin (1st generation B1) versus penicillins  (ampicillin A4), Outcome 15 Maternal skin rash.
6.21
6.21. Analysis
Comparison 6  Cephalosporin (1st generation B1) versus penicillins  (ampicillin A4), Outcome 21 Maternal length of hospital stay.
7.1
7.1. Analysis
Comparison 7 Cephalosporin (2nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 1 Maternal sepsis.
7.2
7.2. Analysis
Comparison 7 Cephalosporin (2nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 2 Maternal endometritis.
7.5
7.5. Analysis
Comparison 7 Cephalosporin (2nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 5 Maternal fever (febrile morbidity).
7.6
7.6. Analysis
Comparison 7 Cephalosporin (2nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 6 Maternal wound infection.
7.7
7.7. Analysis
Comparison 7 Cephalosporin (2nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 7 Maternal urinary tract infection.
7.10
7.10. Analysis
Comparison 7 Cephalosporin (2nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 10 Maternal composite adverse effects.
7.15
7.15. Analysis
Comparison 7 Cephalosporin (2nd generation B2) versus penicillins (extended‐spectrum A3), Outcome 15 Maternal skin rash.
8.1
8.1. Analysis
Comparison 8 Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4), Outcome 1 Maternal sepsis.
8.2
8.2. Analysis
Comparison 8 Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4), Outcome 2 Maternal endometritis.
8.5
8.5. Analysis
Comparison 8 Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4), Outcome 5 Maternal fever (febrile morbidity).
8.6
8.6. Analysis
Comparison 8 Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4), Outcome 6 Maternal wound infection.
8.7
8.7. Analysis
Comparison 8 Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4), Outcome 7 Maternal urinary tract infection.
8.10
8.10. Analysis
Comparison 8 Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4), Outcome 10 Maternal composite adverse effects.
8.11
8.11. Analysis
Comparison 8 Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4), Outcome 11 Maternal allergic reactions.
8.15
8.15. Analysis
Comparison 8 Cephalosporin (2nd generation B2) versus penicillins (ampicillin A4), Outcome 15 Maternal skin rash.
9.1
9.1. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 1 Maternal sepsis.
9.2
9.2. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 2 Maternal endometritis.
9.6
9.6. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 6 Maternal wound infection.
9.7
9.7. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 7 Maternal urinary tract infection.
9.9
9.9. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 9 Maternal composite serious infectious complication.
9.10
9.10. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 10 Maternal composite adverse effects.
9.11
9.11. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 11 Maternal allergic reactions.
9.12
9.12. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 12 Maternal nausea.
9.13
9.13. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 13 Maternal vomiting.
9.14
9.14. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 14 Maternal diarrhoea.
9.15
9.15. Analysis
Comparison 9 Cephalosporin (3rd generation B3) versus penicillins (extended‐spectrum A3), Outcome 15 Maternal skin rash.
10.2
10.2. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 2 Maternal endometritis.
10.5
10.5. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 5 Maternal fever (febrile morbidity).
10.6
10.6. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 6 Maternal wound infection.
10.7
10.7. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 7 Maternal urinary tract infection.
10.9
10.9. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 9 Maternal composite serious infectious complication.
10.10
10.10. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 10 Maternal composite adverse effects.
10.11
10.11. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 11 Maternal allergic reactions.
10.13
10.13. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 13 Maternal vomiting.
10.15
10.15. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 15 Maternal skin rash.
10.21
10.21. Analysis
Comparison 10 Cephalosporin (3rd generation B3) versus penicillins (ampicillins A4), Outcome 21 Maternal length of hospital stay.
11.1
11.1. Analysis
Comparison 11 Fluoroquinolones (C) vs penicillins  (A), Outcome 1 Maternal sepsis.
11.2
11.2. Analysis
Comparison 11 Fluoroquinolones (C) vs penicillins  (A), Outcome 2 Maternal endometritis.
11.6
11.6. Analysis
Comparison 11 Fluoroquinolones (C) vs penicillins  (A), Outcome 6 Maternal wound infection.
11.7
11.7. Analysis
Comparison 11 Fluoroquinolones (C) vs penicillins  (A), Outcome 7 Maternal urinary tract infection.
12.1
12.1. Analysis
Comparison 12 Fluoroquinolones (C) vs cephalosporins (B), Outcome 1 Maternal sepsis.
12.2
12.2. Analysis
Comparison 12 Fluoroquinolones (C) vs cephalosporins (B), Outcome 2 Maternal endometritis.
12.6
12.6. Analysis
Comparison 12 Fluoroquinolones (C) vs cephalosporins (B), Outcome 6 Maternal wound infection.
12.7
12.7. Analysis
Comparison 12 Fluoroquinolones (C) vs cephalosporins (B), Outcome 7 Maternal urinary tract infection.
13.2
13.2. Analysis
Comparison 13 Other antibiotic regimens (D to I) versus penicillins (A), Outcome 2 Maternal endometritis.
13.6
13.6. Analysis
Comparison 13 Other antibiotic regimens (D to I) versus penicillins (A), Outcome 6 Maternal wound infection.
14.2
14.2. Analysis
Comparison 14 Other antibiotic regimens (D to I) versus cephalosporins (B), Outcome 2 Maternal endometritis.
14.5
14.5. Analysis
Comparison 14 Other antibiotic regimens (D to I) versus cephalosporins (B), Outcome 5 Maternal fever (febrile morbidity).
14.6
14.6. Analysis
Comparison 14 Other antibiotic regimens (D to I) versus cephalosporins (B), Outcome 6 Maternal wound infection.
14.7
14.7. Analysis
Comparison 14 Other antibiotic regimens (D to I) versus cephalosporins (B), Outcome 7 Maternal urinary tract infection.
15.2
15.2. Analysis
Comparison 15 Other antibiotic regimens versus different antibiotic regimens, Outcome 2 Maternal endometritis.
15.6
15.6. Analysis
Comparison 15 Other antibiotic regimens versus different antibiotic regimens, Outcome 6 Maternal wound infection.
15.7
15.7. Analysis
Comparison 15 Other antibiotic regimens versus different antibiotic regimens, Outcome 7 Maternal urinary tract infection.
15.27
15.27. Analysis
Comparison 15 Other antibiotic regimens versus different antibiotic regimens, Outcome 27 Stillbirth (not‐prespecified).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Ahmed 2004 {published data only}
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References to studies excluded from this review

Andrews 2003 {published data only}
    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;101:1183‐9. - PubMed
Baheraie 1997 {published data only}
    1. Baheraie A, Modares M, Azimi Kh, Mahmodi M. Single‐dose cefazolin prophylaxis for cesarean section. Acta Obstetricia et Gynecologica Scandinavica 1997;76:28.
Beksac 1989 {published data only}
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Berkeley 1990 {published data only}
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Bernstein 1994 {published data only}
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Bilgin 1998 {published data only}
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Boothby 1984 {published data only}
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Carlson 1990 {published data only}
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Chamberlain 1993 {published data only}
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Chittacharoen 1998 {published data only}
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Conover 1984 {published data only}
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Crombleholme 1987 {published data only}
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Crombleholme 1989 {published data only}
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Cunningham 1983 {published data only}
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D'Angelo 1980 {published data only}
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De Palma 1980 {published data only}
    1. Palma R, Leveno K, Cunningham FG, Pope T, Kappus S, Roark M, et al. Identification and management of women at high risk for pelvic infection following cesarean section. Obstetrics & Gynecology 1980;55(5):185S‐191S. - PubMed
De Palma 1982 {published data only}
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Digumarthi 2008 {published data only}
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Ding 2000 {published data only}
    1. Ding H, Wang Y, Liu X. Effects of elective cesarean section and antibiotics to the bacterial flora in female genital tract. Chung‐Hua Fu Chan Ko Tsa Chih [Chinese Journal of Obstetrics & Gynecology] 2000;35(6):342‐4. - PubMed
Donnenfeld 1986 {published data only}
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Duff 1987 {published data only}
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Elliot 1982 {published data only}
    1. Elliott J, Freeman R, Dorchester W. Short versus long course of prophylactic antibiotics in cesarean section. American Journal of Obstetrics and Gynecology 1982;143:740‐4. - PubMed
Elliot 1986 {published data only}
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Flaherty 1983 {published data only}
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Fugere 1983 {published data only}
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Galask 1989 {published data only}
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Gall 1987 {published data only}
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Gonen 1986 {published data only}
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Gonik 1985 {published data only}
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Gonik 1994 {published data only}
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Gordon 1982 {published data only}
    1. Gordon SF, Russell J. A randomized controlled study comparing ceftizoxime, cefamandole, and cefoxitin in obstetric and gynaecological surgery: a preliminary report. Journal of Antimicrobial Chemotherapy 1982;10 Suppl C:289‐92. - PubMed
Grujic 2009 {published data only}
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Gul 1999 {published data only}
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Hager 1991 {published data only}
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Hartert 1987 {published data only}
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Hawrylyshyn 1983 {published data only}
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Ijarotimi 2012 {published data only}
    1. Ijarotimi OA, Badejoko OO, Ijarotimi OO, Orji EO, Loto OM, Fasubaa OB. Comparison of short versus long term antibiotic prophylaxis in elective caesarean section‐the ile‐ife experience. International Journal of Gynecology and Obstetrics 2012;119(Suppl 3):S375.
Itskovitz 1979 {published data only}
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Jakobi 1988 {published data only}
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Kreutner 1979 {published data only}
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Lavery 1986 {published data only}
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Leonetti 1989 {published data only}
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Leveno 1984 {published data only}
    1. Leveno K, Quirk J, Cunningham F, Nelson S, Bawdon R. Perioperative antimicrobials at cesarean section: lavage versus three intravenous doses. American Journal of Obstetrics and Gynecology 1984;149:463‐4. - PubMed
Levin 1983 {published data only}
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Luttkus 1997 {published data only}
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Lyimo 2012 {published data only}
    1. Lyimo FM, Massinde AN, Kidenya BR, Konje E, Mshana SE. Efficacy of single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post‐caesarean infection: study protocol for a randomized controlled trial. Trials 2012;13:89. - PMC - PubMed
Macones 2008 {published data only}
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Maggioni 1998 {published data only}
    1. Maggioni P, Stefano F, Facchini V, Irato S, Mancuso S, Colombo M, et al. Treatment of obstetric and gynecologic infections with meropenem: comparison with imipenem/cilastatin. Journal of Chemotherapy 1998;10:114‐21. - PubMed
Major 1999 {published data only}
    1. Major CA, Reimbold T, Morgan MA. Cephararin versus cefoxitin prophylaxis for cesarean sections. American Journal of Obstetrics and Gynecology 1999;180(1 Pt 2):S75.
Mansani 1984 {published data only}
    1. Mansani FE, Caltabiano M, Condemi V, Scarpignato C. Short‐ or long‐term antibiotic prophylaxis in obstetrical and gynecological surgery?. Acta Bio‐Medica de l Ateneo Parmense 1984;55:147‐51. - PubMed
Masse 1988 {published data only}
    1. Masse A, Turgeon P, Gay N, Verschelden G. To compare the efficacy of antibiotic prophylaxis with cefoxitine using one or three doses at caesarean [Efficacite comparee de l'antibioprophylaxie par la cefoxitine en une ou trois doses dans la cesarienne]. Canadian Medical Association Journal 1988;138:921‐4. - PMC - PubMed
Mathelier 1992 {published data only}
    1. Mathelier A. A comparison of postoperative morbidity following prophylactic antibiotic administration by combined irrigation and intravenous route or by intravenous route alone during cesarean section. Journal of Perinatal Medicine 1992;20:177‐82. - PubMed
McGregor 1986 {published data only}
    1. McGregor J, French J, Makowski E. Single‐dose cefotetan versus multidose cefoxitin for prophylaxis in cesarean section in high‐risk patients. American Journal of Obstetrics and Gynecology 1986;154:955‐60. - PubMed
McGregor 1988 {published data only}
    1. McGregor J, Gordon S, Krotec J, Poindexter A. Results of a randomized, multicenter, comparative trial of a single dose of cefotetan versus multiple doses of cefoxitin as prophylaxis in cesarean section. American Journal of Obstetrics and Gynecology 1988;158:701‐6. - PubMed
Meyer 2000 {published data only}
    1. Meyer NL, Scott K, Hosier K, Sibai B. Cefazolin versus cefazolin/metronidazole for antibiotic prophylaxis at cesarean section [abstract]. Obstetrics & Gynecology 2000;95(4 Suppl):74S.
Meyer 2003 {published data only}
    1. Meyer NL, Hosier KV, Scott K, Lipscomb GH. Cefazolin versus cefazolin plus metronidazole for antibiotic prophylaxis at cesarean section. Southern Medical Journal 2003;96(10):992‐5. - PubMed
Neuman 1990 {published data only}
    1. Neuman M, Langer R, Bachar R, Golan A, Bukovsky I, Caspi E. Penicillin‐tetracycline prophylaxis in cesarean delivery: prospective and randomized comparison of short and long term therapy. Journal of Perinatal Medicine 1990;18:145‐8. - PubMed
O'Leary 1986 {published data only}
    1. O'Leary J, Mullins J, Andrinopoulos G. Ampicillin vs. ampicillin‐gentamicin prophylaxis in high‐risk primary cesarean section. Journal of Reproductive Medicine 1986;31(1):27‐30. - PubMed
Ovalle 1996 {published data only}
    1. Ovalle SA, Robinovich Tannenbaum J, Leyton H, Nilo C, Nasra J, Aliaga J, et al. Antibiotic prophylaxis in the cesarean surgery [Profilaxis antibiótica en la operación cesárea]. Revista Chilena De Obstetricia y Ginecología 1996;61(4):243‐9.
Parsons 1985 {published data only}
    1. Parsons M, Gibson R, Rimando‐Ramos J, Spellacy W. Comparison of single‐dose cefonicid and multiple‐dose cefoxitin for surgical prophylaxis in women undergoing cesarean section. Advances in Therapy 1985;2(5):233‐9.
Patacchiola 2000 {published data only}
    1. Patacchiola F, Paolantonio L, Palermo P, Stefano L, Mascaretti G, Moscarini M. Antibiotic prophylaxis of infective complications after cesarean section. Our experience [Profilassi antibiotica delle complicanze infettive dopo taglio cesareo. Nostra esperienza]. Minerva Ginecologica 2000;52(10):385‐9. - PubMed
Periti 1988 {published data only}
    1. Periti P, Mazzei T, Periti E. Prophylaxis in gynaecological and obstetric surgery: a comparative randomised multicentre study of single‐dose cefotetan versus two doses of cefazolin. Chemioterapia 1988;7(4):245‐52. - PubMed
Peterson 1990 {published data only}
    1. Peterson CM, Medchill M, Gordon D, Chard H. Cesarean prophylaxis: a comparison of cefamandole and cefazolin by both intravenous and lavage routes, and risk factors associated with endometritis. Obstetrics & Gynecology 1990;75:179‐82. - PubMed
Pevzner 2009 {published data only}
    1. Pevzner L, Chan K. Optimal timing for antibiotic prophylaxis during elective cesarean: before or after cord clamping. American Journal of Obstetrics and Gynecology 2009;201(6 Suppl 1):S225‐S226.
Prasuna 2011 {published data only}
    1. Prasuna NJL. Comparative study between prophylactic and routine antibiotic in elective and emergency caesarean section, using coamoxyclav vs ampicillin and gentamicin respectively. 54th All India Congress of Obstetrics and Gynaecology; 2011 January 5‐9; Hyderabad, Andhra Pradesh, India. 2011:124.
Puri 1991 {published data only}
    1. Puri M, Chadda P, Nagrani R, Tandon G. Single dose cephexin prophylaxis for caesarean section. Journal of Obstetrics and Gynaecology of India 1991;41(5):643‐6.
Rayburn 1985 {published data only}
    1. Rayburn W, Varner M, Galask R, Petzold CR, Piehl E. Comparison of moxalactam and cefazolin as prophylactic antibiotics during cesarean section. Antimicrobial Agents and Chemotherapy 1985;27:337‐9. - PMC - PubMed
Rijhsinghani 1995 {published data only}
    1. Rijhsinghani A, Savapoulos SE, Walters JK, Huggins G, Hibbs JR. Ampicillin/sulbactam vs ampicillin alone for Cesarean section prophylaxis: a randomized double‐blind trial. American Journal of Perinatology 1995;12:322‐4. - PubMed
Rodriguez 1990 {published data only}
    1. Rodriguez GC, Gall SA, Parsons MT. Timing of prophylactic antibiotic administration at cesarean section. Proceedings of 10th Annual Meeting of Society of Perinatal Obstetricians; 1990 Jan 23‐27; Houston, Texas, USA. 1990:311.
Roex 1987 {published data only}
    1. Roex AJM, Puyenbroek JI, Loenen AC, Arts NFT. Single‐ versus three‐dose cefoxitin prophylaxis in caesarean section: a randomized clinical trial. European Journal of Obstetrics & Gynecology and Reproductive Biology 1987;25:293‐8. - PubMed
Roy 2003 {published data only}
    1. Roy S, Higareda I, Angel‐Muller E, Ismail M, Hague C, Adeyi B, et al. Ertapenem once a day versus piperacillin‐tazobactam every 6 hours for treatment of acute pelvic infections: a prospective, multicenter, randomized, double‐blind study. Infectious Diseases in Obstetrics and Gynecology 2003;11(1):27‐37. - PMC - PubMed
Saravolatz 1985 {published data only}
    1. Saravolatz L, Lee C, Drukker B. Comparison of intravenous administration with intrauterine irrigation with ceforanide for nonelective cesarean section. Obstetrics & Gynecology 1985;66(4):513‐6. - PubMed
Scarpignato 1982 {published data only}
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Seton 1996 {published data only}
    1. Seton DN, Vellema DMM, Schoon MG, Grobler JM. Prophylactic antibiotics and caesarean section: comparing ceftriaxone administration pre‐ and post‐ umbilical cord clamping in terms of maternal and neonatal morbidity. 15th Conference on Priorities in Perinatal Care in Southern Africa; 1996 March 5‐8; Goudini Spa, South Africa. 1996.
Shakya 2010 {published data only}
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Stiver 1983 {published data only}
    1. Stiver HG, Forward K, Livingstone R, Fugere P, LeMay M, Verschelden G, et al. Muliticenter comparison of cefoxitin versus cefazolin for prevention of infectious morbidity after nonelective cesarean section. Obstetrics & Gynecology 1983;143:158‐63. - PubMed
Stiver 1984 {published data only}
    1. Stiver HG, Forward KR, Tyrrell DL, Livingstone RA, Fugere P, Lemay M, et al. Comparative cervical microflora shifts after cefoxitin or cefazolin prophylaxis against infection following cesarean section. American Journal of Obstetrics and Gynecology 1984;149:718‐21. - PubMed
Sullivan 2006 {published data only}
    1. Sullivan S, Smith T, Chang E, Hulsey T, Dorsten J, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity. American Journal of Obstetrics and Gynecology 2006;195(6 Suppl 1):S17. - PubMed
Sullivan 2007 {published data only}
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Tassi 1987 {published data only}
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Teansutikul 1993 {published data only}
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Thigpen 2005 {published data only}
    1. Thigpen BD, Hood WA, Chauhan S, Bufkin L, Bofill J, Magann E, et al. Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial. American Journal of Obstetrics and Gynecology 2005;192:1864‐71. - PubMed
van Beekhuizen 2008 {published data only}
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van Velzen 2009 {published data only}
    1. Velzen C, Kolk P, Westen E, Mmuni N, Hamisi A, Nakua R, et al. Comparison of a single prophylactic dose of ampicillin and metronidazole before caesarean section with a multiple day regimen of these antibiotics in prevention of postpartum maternal infection in a low resource setting: a randomized controlled trial. International Journal of Gynecology & Obstetrics 2009;107(Suppl 2):S369.
Varner 1986 {published data only}
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von Mandach 1993 {published data only}
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Warnecke 1982 {published data only}
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Watts 1991 {published data only}
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    1. Wax JR, Hersey K, Philput C, Wright MS, Nichols KV, Eggleston MK, et al. Single dose cefazolin prophylaxis for postcesarean infections: before vs after cord clamping. Journal of Maternal Fetal Medicine 1997;6(1):61‐5. - PubMed
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Yildirim 2009 {published data only}
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References to studies awaiting assessment

Deng 2007 {published data only}
    1. Deng DM, Huang Z, Yuan WJ, Ding LZ, Chen XY. Clinical study on coadministration of cefazolin sodium and metronidazole for infection prophylaxis in perioperative period of cesarean section. Pharmaceutical Care and Research 2007;7(4):278‐80.
Ijarotimi 2013 {published data only}
    1. Ijarotimi AO, Badejoko OO, Ijarotimi O, Loto OM, Orji EO, Fasubaa OB. Comparison of short versus long term antibiotic prophylaxis in elective caesarean section at the Obafemi Awolowo University Teaching Hospitals Complex, Ile‐Ife, Nigeria. Nigerian Postgraduate Medical Journal 2013;20(4):325‐30. - PubMed

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