Chorioamnionitis: is continuation of antibiotic therapy necessary after cesarean section?
OBJECTIVE
Our purpose was to determine whether the continuation of antibiotics postoperatively after cesarean section in patients whose labors were complicated by chorioamnionitis would reduce the incidence of endometritis.


METHODS
Patients with a clinical diagnosis of chorioamnionitis treated with ampicillin during labor and who required cesarean delivery for obstetric indications received preoperative intravenous clindamycin and gentamicin and were randomized into 2 groups. Group 1 received no scheduled postoperative antibiotics and group 2 continued to receive clindamycin 900 mg every 8 hours and gentamicin 1.5 mg/kg every 8 hours until afebrile for a minimum of 24 hours (temperature </=100 degreesF).


RESULTS
Sixty-one patients were randomized to group 1 and 55 patients were randomized to group 2. The duration of labor, the duration of membrane rupture, and the number of intrapartum vaginal examinations were statistically insignificant between the 2 groups. The mean duration of maternal postoperative hospital stay was 4 days for both groups. There were no statistically significant differences in the rate of endometritis for group 1, 9 of 61 (14.8%), versus group 2, 12 of 55 (21.8%), P =.32.


CONCLUSIONS
In patients whose labors were complicated by chorioamnionitis and who underwent cesarean section, the continuation of preoperative clindamycin and gentamicin in the postoperative period did not reduce the risk of endometritis compared with a single preoperative dose.
Turnquest
M A
MA
Divisions of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, University of Louisville School of Medicine, Louisville, Kentucky, USA.
How
H Y
HY
Cook
C R
CR
O'Rourke
T P
TP
Cureton
A C
AC
Spinnato
J A
JA
Brown
H L
HL
D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000188:drug therapy*; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004716:Endometritis / Q000453:epidemiology; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007239:Infections / Q000188:drug therapy; D007275:Injections, Intravenous; D010406:Penicillins / Q000627:therapeutic use; D011247:Pregnancy; D011300:Preoperative Care; D011644:Puerperal Disorders / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D010406:Penicillins; D002981:Clindamycin; D000667:Ampicillin