Changing concepts in obstetric antibiotic prophylaxis

Abstract

The evolution of antibiotic prophylaxis in cesarean section is traced from the discovery of sulfa compounds in the 1940s to the present. Prolonged courses of antibiotics, initiated before the surgical incision, have given way to shorter, three-dose and even single-dose regimens administered after clamping of the umbilical cord. Several factors have been proposed to help identify patients at greatest risk of infection. Guidelines for antibiotic prophylaxis are reviewed. The effects of antibiotics on host flora are described, and the implications of bacterial resistance for selection of a prophylactic agent, particularly with respect to induction of the Richmond-Sykes type I beta-lactamase enzyme, are discussed.