Randomized controlled trial on prevention of postcesarean infection using penicillin and cephalothin in Brazil.
BACKGROUND
There is a need to assess the effects of different antibiotic administration models on infectious complications among women from low-income populations who undergo cesarean delivery, and the cost benefit.


METHODS
Randomized, blinded controlled clinical trial study of a single preoperative dose of cephalothin, versus a postcesarean scheme for infection prophylaxis, versus no antibiotics.


METHODS
The setting was a tertiary Brazilian center with 1,500 deliveries annually. Pregnant women (n = 600) with an indication for emergency or elective cesarean section were randomly allocated consecutively to one of three groups and treated as follows: Group 1 (n = 200), no antibiotics; Group 2 (n = 200), the standard antibiotics scheme followed at this center; Group 3 (n = 200), a single dose of intravenous cephalothin 2 g, intraoperatively.


METHODS
Prevalences of wound infection, puerperal and postcesarean infections, and costs of antibiotics used.


RESULTS
Antibiotics reduced the incidence of puerperal infection, but did not change the percentages of wound and postcesarean infections and no use of antibiotics increased the puerperal infection risk sixfold. Cephalothin reduced the relative risk of puerperal infection by 89% (95% confidence interval: 7-87%). Penicillin reduced it by 78%, but this was not statistically significant. No deaths occurred. The costs of the two schemes were similar (almost US 1.00 dollars). CONCLUSIONS. Prophylactic cephalothin use was associated with decreased postcesarean puerperal infection and presented a cost benefit.
Rudge
Marilza Vieira Cunha
MV
Faculdade de Medicina de Botucatu, Sao Paulo State University, UNESP, Botucatu, Brazil. mrudge@fmb.unesp.br
Atallah
Alvaro Nagib
AN
Peraçoli
José Carlos
JC
Tristão
Andréa da Rocha
Ada R
Mendonça Neto
Moisés
M
D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods*; D001938:Brazil; D002512:Cephalothin / Q000008:administration & dosage* / Q000191:economics; D002585:Cesarean Section / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D010400:Penicillin G / Q000008:administration & dosage* / Q000191:economics; D011203:Poverty; D011247:Pregnancy; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010400:Penicillin G; D002512:Cephalothin