Incidence of postpartum endomyometritis following single-dose antibiotic prophylaxis with either ampicillin/sulbactam, cefazolin, or cefotetan in high-risk cesarean section patients.
OBJECTIVE
To assess the efficacy of single-dose antibiotic prophylaxis against postpartum endomyometritis in high-risk cesarean section patients.


METHODS
Patients were administered one of three single-dose antibiotic regimens following umbilical cord clamping after cesarean section delivery.


METHODS
Prospective randomized trial at a university-based hospital.


METHODS
The study evaluated 293 consenting women undergoing cesarean section who had either experienced labor for a duration of > or = 6 hr or rupture of amniotic membranes.


METHODS
Development of postpartum endomyometritis.


RESULTS
The incidence of postpartum endomyometritis was 7/95 (7.4%) following the ampicillin/sulbactam regimen, 14/98 (14.3%) after the cefazolin regimen, and 11/99 (11.1%) after the cefotetan regimen. There was no significant difference in postpartum infection among the three study arms. In addition, the incidence of endomyometritis in the three single-dose study arms was not higher than previously noted in studies where three doses of antibiotic were administered.


CONCLUSIONS
Single-dose antibiotic prophylaxis should replace the standard triple-dose therapy for uninfected women undergoing cesarean section who are at risk for postoperative endomyometritis. Ampicillin/sulbactam, cefazolin, and cefotetan are all reasonable antibiotic choices for single-dose therapy.
Noyes
N
N
New York University Medical Center, New York 10016, USA.
Berkeley
A S
AS
Freedman
K
K
Ledger
W
W
D000328:Adult; D000667:Ampicillin / Q000008:administration & dosage / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002437:Cefazolin / Q000008:administration & dosage / Q000627:therapeutic use*; D015313:Cefotetan / Q000008:administration & dosage / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D002513:Cephamycins / Q000008:administration & dosage / Q000627:therapeutic use; D002585:Cesarean Section / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D004716:Endometritis / Q000517:prevention & control*; D005321:Extraembryonic Membranes; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007743:Labor, Obstetric; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D013407:Sulbactam / Q000008:administration & dosage / Q000627:therapeutic use
D002511:Cephalosporins; D002513:Cephamycins; D015313:Cefotetan; C035444:sultamicillin; D000667:Ampicillin; D002437:Cefazolin; D013407:Sulbactam