Continuing investigation of women at high risk for infection following cesarean delivery. Three-dose perioperative antimicrobial therapy.
At Parkland Memorial Hospital a group of women at high risk for infection following cesarean delivery was identified. These included nulliparas who underwent cesarean section for cephalopelvic disproportion 6 or more hours following membrane rupture. During the puerperium, uterine infection developed in 85 to 95% of such women, and one third of this high-risk group had associated complications. The authors have previously reported the efficacy antimicrobial agents given to these women at the time of cesarean section and continued for 4 days. The present prospective study was designed to assess the efficacy of a shorter course of perioperative antimicrobial therapy for these high-risk women. Three doses of antimicrobial agents were given perioperatively to 305 women randomly assigned to 1 of 3 treatment regimens: 115 were given penicillin plus gentamicin, 82 received 2, 1, and 1 g of cefamandole, respectively, and the remaining 108 were given 2, 2, and 2 g of cefamandole, respectively. The incidence of uterine infection in these 305 women was 24% and associated complications were identified in 7% of all women. Based upon a comparison of results with the progenitor study, the authors conclude that 3-dose perioperative antimicrobial therapy is preferred to 4 days of treatment for women at high risk for infection following cesarean delivery.
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002435:Cefamandole / Q000008:administration & dosage; D002585:Cesarean Section / Q000009:adverse effects*; D002701:Chloramphenicol / Q000008:administration & dosage; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000209:etiology; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D010400:Penicillin G / Q000008:administration & dosage; D011182:Postoperative Care; D011247:Pregnancy; D011645:Puerperal Infection / Q000517:prevention & control*; D011897:Random Allocation; D012306:Risk
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002435:Cefamandole; D002701:Chloramphenicol; D010400:Penicillin G