Ampicillin/sulbactam versus cefuroxime as antimicrobial prophylaxis for cesarean delivery: a randomized study.
BACKGROUND
The efficacy and safety of a single dose of ampicillin/sulbactam compared to a single dose of cefuroxime at cord clamp for prevention of post-cesarean infectious morbidity has not been assessed.


METHODS
Women scheduled for cesarean delivery were randomized to receive a single dose of either 3 g of ampicillin-sulbactam or 1.5 g of cefuroxime intravenously, after umbilical cord clamping. An evaluation for development of postoperative infections and risk factor analysis was performed.


RESULTS
One hundred and seventy-six patients (median age 28 yrs, IQR: 24-32) were enrolled in the study during the period July 2004-July 2005. Eighty-five (48.3%) received cefuroxime prophylaxis and 91 (51.7%) ampicillin/sulbactam. Postoperative infection developed in 5 of 86 (5.9%) patients that received cefuroxime compared to 8 of 91 (8.8%) patients that received ampicillin/sulbactam (p=0.6). In univariate analyses 6 or more vaginal examinations prior to the operation (p=0.004), membrane rupture for more than 6 hours (p=0.08) and blood loss greater than 500 ml (p=0.018) were associated with developing a postoperative surgical site infection (SSI). In logistic regression having 6 or more vaginal examinations was the most significant risk factor for a postoperative SSI (OR 6.8, 95% CI: 1.4-33.4, p=0.019). Regular prenatal follow-up was associated with a protective effect (OR 0.04, 95% CI: 0.005-0.36, p=0.004).


CONCLUSIONS
Ampicillin/sulbactam was as safe and effective as cefuroxime when administered for the prevention of infections following cesarean delivery.


BACKGROUND
Clinicaltrials.gov identifier: NCT01138852.
Department of Obtsterics and Gynecology, University General Hospital of Heraclion, Heracleion, Greece.
Eleftherios
E
Ziogos
Sotirios
S
Tsiodras
Ioannis
I
Matalliotakis
Helen
H
Giamarellou
Kyriaki
K
Kanellakopoulou
D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002444:Cefuroxime / Q000627:therapeutic use*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D011247:Pregnancy; D011446:Prospective Studies; D011645:Puerperal Infection / Q000517:prevention & control; D012307:Risk Factors; D013407:Sulbactam / Q000627:therapeutic use*; D055815:Young Adult
D000890:Anti-Infective Agents; D000667:Ampicillin; D002444:Cefuroxime; D013407:Sulbactam