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Meta-Analysis
. 2021 Mar 4;3(3):CD008726.
doi: 10.1002/14651858.CD008726.pub3.

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

Myfanwy J Williams  1 , Carolina Carvalho Ribeiro do Valle  2 , Gillian Ml Gyte  1
Affiliations
Meta-Analysis

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

Myfanwy J Williams et al. Cochrane Database Syst Rev. .

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, considering their effectiveness in reducing infectious complications for women and adverse effects on both mother and infant.

Search methods: For this 2020 update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (2 December 2019), and reference lists of retrieved studies.

Selection criteria: We included randomised controlled trials (RCTs) comparing different classes of prophylactic antibiotics given to women undergoing caesarean section. RCTs published in abstract form were also included. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane Reviews. We excluded quasi-RCTs and cross-over trials. Cluster-RCTs were eligible for inclusion but none were identified.

Data collection and analysis: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We assessed the certainty of the evidence using the GRADE approach.

Main results: We included 39 studies, with 33 providing data (8073 women). Thirty-two studies (7690 women) contributing data administered antibiotics systemically, while one study (383 women) used lavage and was analysed separately. We identified three main comparisons that addressed clinically important questions on antibiotics at caesarean section (all systemic administration), but we only found studies for one comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found no studies for the following comparisons: 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides' and 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides plus aminoglycosides'. Twenty-seven studies (22 provided data) included comparisons of cephalosporins (only) versus penicillins (only). However for this update, we only pooled data relating to different sub-classes of penicillins and cephalosporins where they are known to have similar spectra of action against agents likely to cause infection at caesarean section. Eight trials, providing data on 1540 women, reported on our main comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found data on four other comparisons of cephalosporins (only) versus penicillins (only) using systemic administration: antistaphylococcal cephalosporins (1st and 2nd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (9 studies, 3093 women); minimally antistaphylococcal cephalosporins (3rd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (4 studies, 854 women); minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum penicillins plus betalactamase inhibitors (2 studies, 865 women); and minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum and antistaphylococcal penicillins (1 study, 200 women). For other comparisons of different classes of antibiotics, only a small number of trials provided data for each comparison, and in all but one case data were not pooled. For all comparisons, there was a lack of good quality data and important outcomes often included few women. Three of the studies that contributed data were undertaken with drug company funding, one was funded by the hospital, and for all other studies the funding source was not reported. Most of the studies were at unclear risk of selection bias, reporting bias and other biases, partly due to the inclusion of many older trials where trial reports did not provide sufficient methodological information. We undertook GRADE assessment on the only main comparison reported by the included studies, antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors, and the certainty ranged from low to very low, mostly due to concerns about risk of bias, wide confidence intervals (CI), and few events. In terms of the primary outcomes for our main comparison of 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors': only one small study reported sepsis, and there were too few events to identify clear differences between the drugs (risk ratio (RR) 2.37, 95% CI 0.10 to 56.41, 1 study, 75 women, very low-certainty evidence). There may be little or no difference between these antibiotics in preventing endometritis (RR 1.10; 95% CI 0.76 to 1.60, 7 studies, 1161 women; low-certainty evidence). None of the included studies reported on infant sepsis or infant oral thrush. For our secondary outcomes, we found there may be little or no difference between interventions for maternal fever (RR 1.07, 95% CI 0.65 to 1.75, 3 studies, 678 women; low-certainty evidence). We are uncertain of the effects on maternal: wound infection (RR 0.78, 95% CI 0.32 to 1.90, 4 studies, 543 women), urinary tract infection (average RR 0.64, 95% CI 0.11 to 3.73, 4 studies, 496 women), composite adverse effects (RR 0.96, 95% CI 0.09 to 10.50, 2 studies, 468 women), and skin rash (RR 1.08, 95% CI 0.28 to 4.1, 3 studies, 591 women) (all very low certainty evidence). Although maternal allergic reactions were reported by two studies, there were no events. There were no infant outcomes reported in the included studies. For the other comparisons, the results for most outcomes had wide CIs, few studies and few women included. None of the included trials reported on longer-term maternal outcomes, or on any infant outcomes.

Authors' conclusions: Based on the best currently available evidence, 'antistaphylococcal cephalosporins' and 'broad spectrum penicillins plus betalactamase inhibitors' may have similar efficacy at caesarean section when considering immediate postoperative infection, although we did not have clear evidence for several important outcomes. Most trials administered antibiotics at or after cord clamping, or post-operatively, so results may have limited applicability to current practice which generally favours administration prior to skin incision. We have no data on any infant outcomes, nor on late infections (up to 30 days) in the mother; these are important gaps in the evidence that warrant further research. Antimicrobial resistance is very important but more appropriately investigated by other trial designs.

Trial registration: ClinicalTrials.gov NCT01138852 NCT02736682.

PubMed Disclaimer

Conflict of interest statement

Gillian ML Gyte: GG received royalties from John Wiley & Sons in respect of ‘A Cochrane Pocketbook – Pregnancy and Childbirth’ Hofmeyr GJ et al. 2008.

Myfanwy J Williams: is employed by the University of Liverpool as a Research Associate at Cochrane Pregnancy and Childbirth. Her role is supported by the World Health Organization.

Carolina Carvalho Ribeiro do Valle: none known.

Figures

1
1
Study flow diagram.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 1: Maternal sepsis
1.2
1.2. Analysis
Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 2: Maternal endometritis
1.3
1.3. Analysis
Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 3: Maternal fever (febrile morbidity)
1.4
1.4. Analysis
Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 4: Maternal wound infection
1.5
1.5. Analysis
Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 5: Maternal urinary tract infection
1.6
1.6. Analysis
Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 6: Maternal composite adverse effects
1.7
1.7. Analysis
Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 7: Maternal allergic reactions
1.8
1.8. Analysis
Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 8: Maternal skin rash
2.1
2.1. Analysis
Comparison 2: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS, Outcome 1: Maternal sepsis
2.2
2.2. Analysis
Comparison 2: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS, Outcome 2: Maternal endometritis
3.1
3.1. Analysis
Comparison 3: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by generation of cephalosporin, Outcome 1: Maternal sepsis
3.2
3.2. Analysis
Comparison 3: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by generation of cephalosporin, Outcome 2: Maternal endometritis
4.1
4.1. Analysis
Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 1: Maternal endometritis
4.2
4.2. Analysis
Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 2: Sensitivity analysis (Fixed effects) Maternal endometritis
4.3
4.3. Analysis
Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 3: Maternal fever (febrile morbidity)
4.4
4.4. Analysis
Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 4: Subgroup analysis by type of cephalosporin Maternal fever (febrile morbidity)
4.5
4.5. Analysis
Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 5: Maternal wound infection
4.6
4.6. Analysis
Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 6: Maternal urinary tract infection
4.7
4.7. Analysis
Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 7: Maternal composite adverse effects
4.8
4.8. Analysis
Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 8: Maternal allergic reactions
4.9
4.9. Analysis
Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 9: Maternal length of hospital stay (days)
5.1
5.1. Analysis
Comparison 5: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS, Outcome 1: Maternal endometritis
6.1
6.1. Analysis
Comparison 6: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by generation of cephalosporin, Outcome 1: Maternal endometritis
7.1
7.1. Analysis
Comparison 7: Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin, Outcome 1: Maternal endometritis
8.1
8.1. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 1: Maternal sepsis
8.2
8.2. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 2: Maternal endometritis
8.3
8.3. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 3: Maternal fever (febrile morbidity)
8.4
8.4. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 4: Maternal wound infection
8.5
8.5. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 5: Maternal urinary tract infection
8.6
8.6. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 6: Maternal composite serious infectious complication
8.7
8.7. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 7: Maternal composite adverse effects
8.8
8.8. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 8: Maternal allergic reactions
8.9
8.9. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 9: Maternal nausea
8.10
8.10. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 10: Maternal vomiting
8.11
8.11. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 11: Maternal diarrhoea
8.12
8.12. Analysis
Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 12: Maternal skin rash
9.1
9.1. Analysis
Comparison 9: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS, Outcome 1: Maternal sepsis
9.2
9.2. Analysis
Comparison 9: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS, Outcome 2: Maternal endometritis
10.1
10.1. Analysis
Comparison 10: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin, Outcome 1: Maternal sepsis
10.2
10.2. Analysis
Comparison 10: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin, Outcome 2: Maternal endometritis
11.1
11.1. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 1: Maternal endometritis
11.2
11.2. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 2: Maternal fever (febrile morbidity)
11.3
11.3. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 3: Maternal wound infection
11.4
11.4. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 4: Maternal urinary tract infection
11.5
11.5. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 5: Maternal composite serious infectious complication
11.6
11.6. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 6: Maternal composite adverse effects
11.7
11.7. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 7: Maternal allergic reactions
11.8
11.8. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 8: Maternal nausea
11.9
11.9. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 9: Maternal vomiting
11.10
11.10. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 10: Maternal diarrhoea
11.11
11.11. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 11: Maternal skin rash
11.12
11.12. Analysis
Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 12: Maternal length of hospital stay
12.1
12.1. Analysis
Comparison 12: Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS, Outcome 1: Maternal endometritis
13.1
13.1. Analysis
Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 1: Maternal endometritis
13.2
13.2. Analysis
Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 2: Maternal fever (febrile morbidity)
13.3
13.3. Analysis
Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 3: Maternal wound infection
13.4
13.4. Analysis
Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 4: Maternal vomiting
13.5
13.5. Analysis
Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 5: Maternal skin rash
14.1
14.1. Analysis
Comparison 14: Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+, Outcome 1: Maternal sepsis
14.2
14.2. Analysis
Comparison 14: Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+, Outcome 2: Maternal endometritis
14.3
14.3. Analysis
Comparison 14: Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+, Outcome 3: Maternal wound infection
14.4
14.4. Analysis
Comparison 14: Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+, Outcome 4: Maternal urinary tract infection
15.1
15.1. Analysis
Comparison 15: Fluoroquinolones F vs cephalosporins C2 (2nd generation), Outcome 1: Maternal sepsis
15.2
15.2. Analysis
Comparison 15: Fluoroquinolones F vs cephalosporins C2 (2nd generation), Outcome 2: Maternal endometritis
15.3
15.3. Analysis
Comparison 15: Fluoroquinolones F vs cephalosporins C2 (2nd generation), Outcome 3: Maternal wound infection
15.4
15.4. Analysis
Comparison 15: Fluoroquinolones F vs cephalosporins C2 (2nd generation), Outcome 4: Maternal urinary tract infection
16.1
16.1. Analysis
Comparison 16: Carbapenems Ca vs cephalosporins C3 (3rd generation), Outcome 1: Maternal endometritis
16.2
16.2. Analysis
Comparison 16: Carbapenems Ca vs cephalosporins C3 (3rd generation), Outcome 2: Maternal fever (febrile morbidity)
16.3
16.3. Analysis
Comparison 16: Carbapenems Ca vs cephalosporins C3 (3rd generation), Outcome 3: Maternal wound infection
16.4
16.4. Analysis
Comparison 16: Carbapenems Ca vs cephalosporins C3 (3rd generation), Outcome 4: Maternal urinary tract infection
17.1
17.1. Analysis
Comparison 17: Macrolides M vs cephalosporins C1 (1st generation), Outcome 1: Maternal fever (febrile morbidity)
18.1
18.1. Analysis
Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 1: Maternal endometritis
18.2
18.2. Analysis
Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 2: Maternal fever (febrile morbidity)
18.3
18.3. Analysis
Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 3: Maternal wound infection
18.4
18.4. Analysis
Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 4: Maternal urinary tract infection
18.5
18.5. Analysis
Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 5: Maternal length of hospital stay (days)
18.6
18.6. Analysis
Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 6: Costs
19.1
19.1. Analysis
Comparison 19: Other antibiotic regimens (multiple classes) vs penicillin (only) regimens, Outcome 1: Maternal endometritis
19.2
19.2. Analysis
Comparison 19: Other antibiotic regimens (multiple classes) vs penicillin (only) regimens, Outcome 2: Maternal fever (febrile morbidity)
19.3
19.3. Analysis
Comparison 19: Other antibiotic regimens (multiple classes) vs penicillin (only) regimens, Outcome 3: Maternal wound infection
19.4
19.4. Analysis
Comparison 19: Other antibiotic regimens (multiple classes) vs penicillin (only) regimens, Outcome 4: Maternal urinary tract infection
20.1
20.1. Analysis
Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 1: Maternal sepsis
20.2
20.2. Analysis
Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 2: Maternal endometritis
20.3
20.3. Analysis
Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 3: Maternal fever (febrile morbidity)
20.4
20.4. Analysis
Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 4: Maternal wound infection
20.5
20.5. Analysis
Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 5: Maternal urinary tract infection
20.6
20.6. Analysis
Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 6: Maternal composite adverse effects
20.7
20.7. Analysis
Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 7: Maternal length of hospital stay
20.8
20.8. Analysis
Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 8: Costs
21.1
21.1. Analysis
Comparison 21: (Irrigation/lavage) cephalosporins vs penicillins, Outcome 1: Maternal endometritis
21.2
21.2. Analysis
Comparison 21: (Irrigation/lavage) cephalosporins vs penicillins, Outcome 2: Maternal fever (febrile morbidity)
21.3
21.3. Analysis
Comparison 21: (Irrigation/lavage) cephalosporins vs penicillins, Outcome 3: Maternal wound infection
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Update of

References

References to studies included in this review

Ahmed 2004 {published data only}
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Deng 2007 {published data only}
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    1. Ford L. Cost of antibiotic prophylaxis in cesarean section. Drug Intelligence and Clinical Pharmacy 1986;20:592-3. - PubMed
Gidiri 2014 {published data only}
    1. Gidiri MF, Ziruma A. A randomised clinical trial evaluating prophylactic single-dose versus a prolonged week-long course of antibiotics for caesarean section at two teaching hospitals in Zimbabwe. BJOG: an international journal of obstetrics and gynaecology 2013;120(Suppl s1):12. - PubMed
    1. Gidiri MF, Ziruma A. A randomized clinical trial evaluating prophylactic single-dose vs prolonged course of antibiotics for caesarean section in a high HIV-prevalence setting. Journal of Obstetrics and Gynaecology 2014;34(2):160-4. - PubMed
Graham 1993 {published data only}
    1. Graham JM, Blanco JD, Oshiro BT, Magee KP, Monga M, Eriksen N. Single-dose ampicillin prophylaxis does not eradicate enterococcus from the lower genital tract. Obstetrics & Gynecology 1993;81:115-7. - PubMed
Jyothi 2010 {published data only}
    1. Jyothi S, Vyas M, Pratap K, Asha K. Antibiotic prophylaxis for hysterectomy and cesarean section: Amoxicillin-clavulanic acid versus cefazolin. Journal of Obstetrics and Gynecology of India 2010;60(5):419-23.
Kamilya 2012 {published data only}
    1. Kamilya G, Seal SL, Mukherji J, Roy H, Bhattacharyya SK, Hazra A. A randomized controlled trial comparing two different antibiotic regimens for prophylaxis at cesarean section. Journal of Obstetrics and Gynecology of India 2012;62(1):35-8. - PMC - PubMed
Kayihura 2003 {published data only}
    1. Kayihura V, Osman NB, Bugalho A, Bergstrom S. Choice of antibiotics for infection prophylaxis in emergency cesarean sections in low-income countries: a cost-benefit study in Mozambique. Acta Obstetricia et Gynecologica Scandinavica 2003;82(7):636-41. - PubMed
Koppel 1992 {published data only}
    1. Koppel R, Kaehler D, Benz J. Effectiveness of single dose antibiotic prophylaxis in caesarean section: comparison between cefotaxim and amoxicillin plus clavulanic acid. Geburtshilfe und Frauenheilkunde 1992;52(2):113-6. - PubMed
Lehapa 1999 {published data only}
    1. Lehapa AM, Towobola OA, Mahapa DH. The comparative efficacy and cost benefit of ceftriaxone versus ampicillin as prophylaxis in patients undergoing caesarean section. In: Women's Health - into the new millennium. Proceedings of the 4th International Scientific Meeting of the Royal College of Obstetricians and Gynaecologists; 1999 October 3-6; Cape Town South Africa. RCOG, 1999:83.
Lewis 1990 {published data only}
    1. Lewis D, Otterson W, Dunnihoo D. Antibiotic prophylactic uterine lavage in cesarean section: a double-blind comparison of saline, ticarcillin, and cefoxitin irrigation in indigent patients. Southern Medical Journal 1990;83(3):274-6. - PubMed
Louie 1982 {published data only}
    1. Louie TJ, Binns B, Baskett T, Ross J, Koss J. Cefotaxime, cefazolin or ampicillin prophylaxis of febrile morbidity in emergency cesarean sections. Clinical Therapeutics 1982;5:83-96. - PubMed
Lumbiganon 1994 {published data only}
    1. Lumbiganon P, Sirivatanapa P, Prasertchareonsook W, Kumlertkit S, Anansuwanchai J. A randomized controlled trial of augmentin vs cefazolin in emergency cesarean section. International Journal of Gynecology & Obstetrics 1994;46:77.
Mansueto 1989 {published data only}
    1. Mansueto G, Tomaselli F. Antibiotic prophylaxis in non-elective caesarean section with single dose imipenem versus multiple-dose cefotaxime [Profilassi antibiotica in pazieti sottoposte a taglio cesareo non di elezione con Imipenem in "single dose" versus cefotaxime in "multiple doses"]. European Review for Medical and Pharmacological Sciences 1989;11:65-8. - PubMed
Mivumbi 2014 {published data only}
    1. Mivumbi V, Greenberg J, Rulisa S. Randomized trial of prophylactic ampicillin vs cefazolin for prevention of post cesarean delivery infectious morbidity in Rwanda. In: 1st FIGO African Regional Conference of Gynecology and Obstetrics; 2013 Oct 2-5; Addis Ababa, Ethiopia. 2013.
    1. Mivumbi VN, Little SE, Rulisa S, Greenberg JA. Prophylactic ampicillin versus cefazolin for the prevention of post-cesarean infectious morbidity in Rwanda. International Journal of Gynecology and Obstetrics 2014;124:244-7. - PubMed
    1. Mivumbi VN, Little SE, Rulisa S, Greenberg JA. Prophylactic ampicillin versus cefazolin for the prevention of post-cesarean infectious morbidity in Rwanda. International Journal of Gynecology and Obstetrics 2015;131(Suppl 5):E284. - PubMed
Mothilal 2013 {published data only}
    1. Mothilal M, Thivya R, Anjalakshi C, Ramesh A, Damodharan N. Comparison of effectiveness of azithromycin and cefazolin in post caesarean section infection. International Journal of Pharmacy and Pharmaceutical Sciences 2013;5(Suppl 3):92-4.
Ng 1992 {published data only}
    1. Ng NK, Sivalingam N. The role of prophylactic antibiotics in caesarean section - a randomized trial. Medical Journal of Malaysia 1992;47(4):273-9. - PubMed
Noyes 1998 {published data only}
    1. Noyes N, Berkeley AS, Freedman K, Ledger W. Incidence of postpartum endomyometritis following single-dose antibiotic prophylaxis with either ampicillin/sulbactam, cefazolin, or cefotetan in high-risk cesarean section patients. Infectious Diseases in Obstetrics and Gynecology 1998;6(5):220-3. - PMC - PubMed
Parulekar 2001 {published data only}
    1. Parulekar P, Kumar S, Awasthi RT, Tarneja P. A single dose of cefotoxime - as a prophylaxis during caesarean section. Journal of Obstetrics and Gynecology of India 2001;51(5):118-21.
Rehu 1980 {published data only}
    1. Rehu M, Jahkola M. Prophylactic antibiotics in caesarean section: effect of a short preoperative course of benzyl penicillin or clindamycin plus gentamicin on postoperative infectious morbidity. Annals of Clinical Research 1980;12:45-8. - PubMed
Rohan 2014 {published data only}
    1. Rohan LC, Hemapriya S, Kodithuwakku KA. Ampicillin and metronidazole versus cefuroxime and metronidazole as antimicrobial prophylaxis for antepartum caesarean section. Sri Lanka Journal of Obstetrics and Gynaecology 2014;36(Suppl 1):67-8, Abstract no: P 42.
Rosaschino 1988 {published data only}
    1. Rosaschino P, Palmerio G, Ziliani A, Gambarini A, Zambetti E, Bagolan M. Antibiotic prophylaxis in cesarean section: a controlled randomized study of mezlocillin vs. ceftriaxone [La profilassi antibiotica nel taglio cesareo: mezlocillina vs. cetriaxone. Studio controllato randomizzato]. Giornale Italiano di Ostetricia e Ginecologia 1988;10(8):587-8.
Rudge 2006 {published data only}
    1. Rudge M, Atallah AN, Peracoli JC, Tristao AD, Neto MM. Randomized controlled trial on prevention of postcesarean infection using penicillin and cephalothin in Brazil. Acta Obstetricia et Gynecologica Scandinavica 2006;85(8):945-8. - PubMed
Saltzman 1985 {published data only}
    1. Saltzman DH, Eron LJ, Toy C, Protomastro LJ, Sites JG. Ticarcillin plus clavulanic acid versus cefoxitin in the prophylaxis of infection after cesarean section. American Journal of Medicine 1985;79(Suppl 5B):172-3. - PubMed
Saltzman 1986 {published data only}
    1. Saltzman D, Eron L, Tuomala R, Protomastro L, Sites J. Single-dose antibiotic prophylaxis in high-risk patients undergoing cesarean section. A comparative trial. Journal of Reproductive Medicine 1986;31:709-12. - PubMed
Shah 1998 {published data only}
    1. Shah S, Mazher Y, John IS. Single or triple dose piperacillin prophylaxis in elective cesarean section. International Journal of Gynecology & Obstetrics 1998;62(1):23-9. - PubMed
Spinnato 2000 {published data only}
    1. Spinnato JA, Youkilis B, Cook VD, Pietrantoni M, Clark AL, Gall SA. Antibiotic prophylaxis at cesarean delivery. Journal of Maternal-Fetal Medicine 2000;9:348-50. - PubMed
van der Linden 1993 {published data only}
    1. Der Linden MC, Van Erp EJ, Ruijs GJ, Holm JP. A prospective randomized study comparing amoxycillin/clavulanate with cefuroxime plus metronidazole for perioperative prophylaxis in gynaecological surgery. European Journal of Obstetrics & Gynecology and Reproductive Biology 1993;50:141-5. - PubMed
Voto 1986 {published data only}
    1. Voto LS, Benoliel LA, Amadora Muñiz A, Trepat A, Balsechi EE, Margulies M. Prophylaxis of post cesarean section puerperal infection with the using of cefoxitin antibiotics [Profilaxis de la infección puerperal post-cesarea mediante el uso del antibiótico cefoxitina: I - Resultados de su empleo valorados a través del cultivo sistemático pre, intra y postquirúrgico]. Obstetricia y Ginecologia Latino-Americanas 1986;44:419-24.
Wells 1994 {published data only}
    1. Wells M, McCullough W, Rymer J. Antibiotic prophylaxis in emergency cesarean section. International Journal of Gynecology and Obstetrics 1994;46:77.
Ziogos 2010 {published data only}
    1. Ziogos E, NCT01138852. Ampicillin/sulbactam versus cefuroxime as antimicrobial prophylaxis for cesarean section: a randomized study. clinicaltrials.gov/ct2/show/record/NCT01138852 (first received 7 June 2010).
    1. Ziogos E, Tsiodras S, Matalliotakis I, Giamarellou H, Kanellakopoulou K. Ampicillin/sulbactam versus cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study. BMC Infectious Diseases 2010;10:341. - PMC - PubMed

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
Azizi 2014 {published data only}
    1. Azizi M, IRCT2014041017212N1. Comparison between azithromycin and cephalexin for preventing infection after cesarean section in obese patients. en.irct.ir/trial/15882 (first received 16 June 2016).
    1. Azizi M, Rajaei M, Abbasian M, Ghanbarnejad A Najafian A, Iranfar M. Comparison between azithromycin and cephalexin for preventing Infection after cesarean section in obese patient. International Journal of Clinical Medicine 2014;5:1214-20.
    1. IRCT2014041017212N1. Reduction of infection after caesarean section in obese women with antibiotic prophylaxis [Comparison between azithromycin and cephalexin for preventing infection after cesarean section in obese patients]. Http://www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2014041017212N1 2014. [CENTRAL: CN-01835673]
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}
    1. Beksac MS, Urman CB, Akalin E, Baykal M. A randomized comparative study of a single-dose 3rd generation cephalosporin (ceftriaxone) and a broad spectrum ureidopenicillin (mezlocillin) in a controlled group trial for cesarean section prophylaxis. International Journal of Experimental and Clinical Chemotherapy 1989;2(1):55-7.
Berkeley 1990 {published data only}
    1. Berkeley A, Hirsch J, Freedman K, Ledger W. Cefotaxime for cesarean section prophylaxis in labor; intravenous administration vs lavage. Journal of Reproductive Medicine 1990;35(3):214-8. - PubMed
Bernstein 1994 {published data only}
    1. Bernstein P, Novosel S, Collins JA, Jarrell JF, Joly J, Moutquin JM. Cefotetan versus cefoxitin in cesarean section prophylaxis. Annals of the Royal College of Physicians and Surgeons of Canada 1994;27(7):401-4.
Bilgin 1998 {published data only}
    1. Bilgin T, Ozan H, Dirgen A, Esmer A. Comparison of four different antibiotics as prophylaxis in caesarean section. Journal of Obstetrics and Gynaecology 1998;18(6):546-7. - PubMed
Boothby 1984 {published data only}
    1. Boothby R, Benrubi G, Ferrell E. Comparison of intravenous cefoxitin prophylaxis with intraoperative cefoxitin irrigation for the prevention of post-cesarean-section endometritis. Journal of Reproductive Medicine 1984;29(11):830-2. - PubMed
Carlson 1990 {published data only}
    1. Carlson C, Duff P. Antibiotic prophylaxis for cesarean delivery: is an extended-spectrum agent necessary? Obstetrics & Gynecology 1990;76(3):343-6. - PubMed
Chamberlain 1993 {published data only}
    1. Chamberlain A, White S, Bawdon R, Thomas S, Larsen B. Pharmacokinetics of ampicillin and sulbactam in pregnancy. American Journal of Obstetrics and Gynecology 1993;168:667-73. - PubMed
Chittacharoen 1998 {published data only}
    1. Chittacharoen A, Manonai J, Suthutvoravut S, Phaupradit W. Single-dose amoxycillin-clavulanic acid vs ampicillin prophylaxis in emergency cesarean section. International Journal of Gynecology & Obstetrics 1998;62:249-54.
Conover 1984 {published data only}
    1. Conover W, Moore T. Comparison of irrigation and intravenous antibiotic prophylaxis at cesarean section. Obstetrics & Gynecology 1984;63(6):787-91. - PubMed
    1. Conover WB, Moore TR. Comparison of irrigation and intravenous antibiotic prophylaxis at cesarean section. Obstetrical and Gynecological Survey 1984;39:692-3. - PubMed
Crombleholme 1987 {published data only}
    1. Crombleholme W, Green J, Ohm-Smith M, Dahrouge D, DeKay V, Rideout A, et al. Cesarean section prophylaxis: comparison of two doses with three doses of mezlocillin. American Journal of Reproductive Immunology 1987;13:71-5. - PubMed
Crombleholme 1989 {published data only}
    1. Crombleholme WR, Green JR, Ohm-Smith M, DeKay V, Klaisle C, Luft J, et al. Prophylaxis in caesarean section with cefmetazole and cefoxitin. Journal of Antimicrobial Chemotherapy 1989;23:97-104. - PubMed
Cunningham 1983 {published data only}
    1. Cunningham FG, Leveno KJ, De Palma RT, Roark ML, Rosenfeld CR. Perioperative antimicrobials for cesarean delivery: before or after cord clamping? Obstetrics & Gynecology 1983;62:151-4. - PubMed
D'Angelo 1980 {published data only}
    1. D'Angelo L, Sokol R. Short- versus long-course prophylactic antibiotic treatment in cesarean section patients. Obstetrics & Gynecology 1980;55(5):583-6. - PubMed
De Palma 1980 {published data only}
    1. De 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}
    1. De Palma R, Cunningham G, Leveno K, Roark M. Continuing investigation of women at high risk for infection following cesarean delivery. Obstetrics & Gynecology 1982;60(1):53-9. - PubMed
Digumarthi 2008 {published data only}
    1. Digumarthi L, Gupta S. A single dose of co-amoxiclav vs. five-day antibiotics in elective and emergency caesarean section. BJOG: an international journal of obstetrics and gynaecology 2008;115(s1):159.
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}
    1. Donnenfeld A, Otis C, Weiner S. Antibiotic prophylaxis in cesarean section. Comparison of intrauterine lavage and intravenous administration. Journal of Reproductive Medicine 1986;31(1):15-8. - PubMed
Duff 1987 {published data only}
    1. Duff P, Robertson A, Read J. Single-dose cefazolin versus cefonicid for antibiotic prophylaxis in cesarean delivery. Obstetrics & Gynecology 1987;70(5):718-21. - PubMed
El Aish 2018 {published data only}
    1. El Aish KA, Zourob H, Madi W, El Hams S. Cefazolin alone versus cefazolin, gentamicin, and metronidazole for prophylaxis in women undergoing caesarean section: a randomised controlled trial. Lancet 2018;391:15.
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}
    1. Elliott J, Flaherty J. Comparison of lavage or intravenous antibiotics at cesarean section. Obstetrics & Gynecology 1986;67(1):29-32. - PubMed
Fejgin 1993 {published data only}
    1. Fejgin MD, Markov S, Goshen S, Segal J, Arbel Y, Lang R. Antibiotic for cesarean section: the case for 'true' prophylaxis. International Journal of Gynecology & Obstetrics 1993;43:257-61. - PubMed
Flaherty 1983 {published data only}
    1. Flaherty J, Boswell G, Winkel C, Elliott J. Pharmacokinetics of cefoxitin in patients at term gestation; lavage versus intravenous administration. American Journal of Obstetrics and Gynecology 1983;146:760-6. - PubMed
Fugere 1983 {published data only}
    1. Fugere P, Turgeon P, Boucher M, Verscheiden G, Lemay M. Utilisation des cephalosporines comme antibioprophylaxie lors de cesariennes. Canadian Medical Association Journal 1983;129:132-5. - PMC - PubMed
Galask 1988 {published data only}
    1. Galask R, Benigno B, Cunningham G, Elliott J, Makowski E, McGregor J, et al. Results of a multicenter comparative study of single-dose cefotetan and multiple-dose cefoxitin as prophylaxis in patients undergoing cesarean section. American Journal of Surgery 1988;155:86-90. - PubMed
Galask 1989 {published data only}
    1. Galask RP, Weiner C, Petzold CR. Comparison of single-dose cefmetazole and cefotetan prophylaxis in women undergoing primary caesarean section. Journal of Antimicrobial Chemotherapy 1989;23:105-8. - PubMed
Gall 1987 {published data only}
    1. Gall S, Hill G. Single-dose versus multiple-dose piperacillin prophylaxis in primary cesarean operation. American Journal of Obstetrics and Gynecology 1987;157:502-6. - PubMed
Gideon 2016 {published data only}
    1. Gideon MA, NCT02736682. Single dose ceftriaxone and metronidazole versus multiple doses for antibiotic prophylaxis at elective cesarean section in mulago hospital. a randomized clinical trial. clinicaltrials.gov/show/NCT02736682 (first received 13 April 2016).
Gonen 1986 {published data only}
    1. Gonen R, Samberg I, Levinski R, Levitan Z, Sharf M. Effect of irrigation or intravenous antibiotic prophylaxis on infectious morbidity at cesarean section. Obstetrics & Gynecology 1986;67:545-8. - PubMed
Gonik 1985 {published data only}
    1. Gonik B. Single- versus three-dose cefotaxime prophylaxis for cesarean section. Obstetrics & Gynecology 1985;65:189-93. - PubMed
Gonik 1994 {published data only}
    1. Gonik B, Mcgregor J. Comparison of short vs. long half-life single-dose prophylactic antibiotics for cesarean section. Infectious Diseases in Obstetrics & Gynecology 1994;2:120-5. - PMC - PubMed
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}
    1. Grujic Z, Bogavac M, Ilija G, Nikolic A. Is this necessary to give antibiotic prophylaxis in elective caesarean sections? Journal of Maternal-Fetal and Neonatal Medicine 2010;23(S1):230.
    1. Grujic Z, Sabo A, Grujic I, Kopitovic V, Papovic M. Single dose of antibiotic prophylaxis in elective cesarean sections. Medicinski Pregled 2009;62(3-4):101-6. - PubMed
Gul 1999 {published data only}
    1. Gul A, Zeteroilu I, Surucu R. The comparison of piperacillin use for prophylaxis of post cesarean section infection before and after clamping umbilical cord [abstract]. Infectious Diseases in Obstetrics & Gynecology 1999;7(6):306.
Hager 1991 {published data only}
    1. Hager W, Rapp R, Billeter M, Bradley B. Choice of antibiotic in nonelective cesarean section. Antimicrobial Agents and Chemotherapy 1991;35(9):1782-4. - PMC - PubMed
Hartert 1987 {published data only}
    1. Hartert R, Benrubi G, Thompson R, Nuss R. Cefonicid vs. cefoxitin for cesarean section prophylaxis. Journal of Reproductive Medicine 1987;32(12):907-10. - PubMed
Hawrylyshyn 1983 {published data only}
    1. Hawrylyshyn P, Bernstein P, Papsin F. Short-term antibiotic prophylaxis in high-risk patients following cesarean section. American Journal of Obstetrics and Gynecology 1983;145:285-9. - PubMed
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
    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}
    1. Itskovitz J, Paldi E, Katz M. The effect of prophylactic antibiotics on febrile morbidity following cesarean section. Obstetrics & Gynecology 1979;53(2):162-5. - PubMed
Jakobi 1988 {published data only}
    1. Jakobi P, Weissman A, Zimmer E, Paldi E. Single-dose cefazolin prophylaxis for cesarean section. American Journal of Obstetrics and Gynecology 1988;158:1049-52. - PubMed
Jalai 2019 {published data only}
    1. IRCT20190609043847N1. Prevention of post-cesarean infection [Comparison of cefazolin and cefazolin plus azithromycin regimens in prevention of infection in caesarean section in Shahid Sayyad Shirazi hospital, 2017-2019]. Http://www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20190609043847N1 2019. [CENTRAL: CN-01973986]
Jayawardena 2019 {published data only}
    1. ACTRN12619000018112. The Impact of Azithromycin on Surgical Site Infection Rates [The Impact of Azithromycin on Surgical Site Infection Rates (TIASSIR) in pregnant women undergoing an emergency caesarean section at Redland Hospital]. Http://www.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12619000018112 2019. [CENTRAL: CN-01948712]
Kreutner 1979 {published data only}
    1. Kreutner K, Del Bene V, DeLamar D, Bodden J, Loadholt C. Perioperative cephalosporin prophylaxis in cesarean section: effect on endometritis in the high-risk patient. American Journal of Obstetrics and Gynecology 1979;134:925-33. - PubMed
Lavery 1986 {published data only}
    1. Lavery J, Huang K, Koontz W, Reinstine J, Marcell C, Rosenberg N. Mezlocillin prophylaxis against infection after cesarean section: a comparison of techniques. Southern Medical Journal 1986;79(10):1248-351. - PubMed
Leonetti 1989 {published data only}
    1. Leonetti H, Yun H, O'Leary J, Greenberg A. Single versus multiple dose piperacillin in high risk primary cesarean section. American Journal of Gynecologic Health 1989;3(6):29-32.
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}
    1. Levin DK, Gorchels C, Andersen R. Reduction of post-cesarean section infectious morbidity by means of antibiotic irrigation. American Journal of Obstetrics and Gynecology 1983;147(3):273-6. - PubMed
Luttkus 1997 {published data only}
    1. Luttkus A, Fiebelkorn J, Dudenhausen W. Antibiotic prophylaxis in cases of emergency caesarean section. Geburtshilfe und Frauenheilkunde 1997;57(9):510-4.
Lyimo 2013 {published data only}ISRCTN44462542
    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
    1. Lyimo FM, Massinde AN, Kidenya BR, Konje ET, Mshana SE. Single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean infection at Bugando Medical Centre in Mwanza, Tanzania: a randomized, equivalence, controlled trial. BMC Pregnancy and Childbirth 2013;13:123. - PMC - PubMed
    1. Massinde A, ISRCTN44462542. Efficacy of single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post caesarean infection: a randomised controlled trial. isrctn.com/ISRCTN44462542 (first received 5 September 2011).
Macones 2008 {published data only}
    1. Macones G, Cleary K, Odibo A, Gross G, Parry S, Rampersad R, et al. Timing of antibiotic prophylaxis at cesarean - results of an RCT. American Journal of Obstetrics and Gynecology 2008;199(6 Suppl 1):S33.
Maggioni 1998 {published data only}
    1. Maggioni P, Di 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
Mihailovic 1989 {published data only}
    1. Mihailovic M, Hani A, Klainguti A, Soldini G. Antimicrobial prophylaxis in non-infected patients undergoing abdominal or vaginal hysterectomy or cesarean section. Comparative efficacy of a single preoperative dose of ceftriaxone and of multiple doses of combined amoxicillin plus metronidazole and of amoxicillin alone. Journal of Chemotherapy 1989;1(4 Suppl):1029-30. - PubMed
Mokhtar 2019 {published data only}
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Rayburn 1985 {published data only}
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Roex 1987 {published data only}
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References to ongoing studies

Abdalmageed 2019 {published data only}
    1. NCT04009772. Single dose cefepime versus cefuroxime plus metronidazole as a prophylactic antibiotic during emergency intrapartum cesarean section [Single dose cefepime versus cefuroxime plus metronidazole as a prophylactic antibiotic: a randomized controlled study]. Https://clinicaltrials.gov/show/nct04009772 (first received 4 July 2019). [CENTRAL: CN-01951287]
Karamali 2013 {published data only}
    1. IRCT2013080710511N2. Comparison of prophylactic administration of cefazolin, ampicillin and azithromycin in prevention of postpartum infections after cesarean. Http://www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2013080710511N2 (first received 2013. [CENTRAL: CN-01816174]

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