A randomized trial of penicillin and streptomycin in the prevention of post-partum infection in Uganda

Abstract

We report findings of a randomized trial of penicillin and streptomycin to prevent post-partum infection conducted on 737 women who delivered consecutively at Kawempe Maternity Centre (KMC) in Kampala from 1st October, 1989 to 31st May, 1990. The objectives were: (i) to identify clinical post-partum infection using at least two of its symptoms and signs (fever, lower abdominal pain, lower abdominal tenderness, vaginal discharge); (ii) to identify the causes of post-partum infection using laboratory methods; and (iii) evaluate the effectiveness of prophylactic fortified procaine penicillin (PPF) and streptomycin on post-partum infection. Clinical infection occurred in 36.4% of the group not given antibiotics, 23.3% in the PPF group and 20.3% in the streptomycin group. Laboratory-confirmed infection occurred in 15.5% of the group not given antibiotics, 9.2% in the PPF group and 8.4% in the streptomycin group. However, severe laboratory-confirmed infection (severe clinical infection plus positive laboratory findings) occurred in 4.9% of the group not given antibiotics, 6.1% in the PPF group and 6.6% in the streptomycin group. In general, the organisms isolated included enterobacteria (35.9%), yeast and protozoa (31.6%), staphylococci (23.9%), streptococci (69%) and Neisseria (1.7%). The advantage of PPF and streptomycin was evident in most subgroups defined by clinical characteristics or laboratory findings. In view of the findings in this study, we believe that prophylactic antibiotics given in labor may have a role to play at reducing the incidence of post-partum infection. However, as the cost of antibiotics in developing countries is significant, the development of resistant organisms due to indiscriminate antibiotic use is also a concern and health resources are best used when targeted at specific populations, we feel that antibiotic prophylaxis should not be used routinely and that a more realistic view can be obtained by studying high-risk groups of women with more severe infection.