title: Timing of administration of prophylactic antibiotics for caesarean section: a systematic review and meta-analysis.
abstract: BACKGROUND
  Prophylactic antibiotics reduce infectious morbidity from caesarean section. The timing of their administration, however, is a matter of controversy.
  
  
  OBJECTIVE
  To examine maternal and neonatal infectious morbidity in women receiving preoperative prophylaxis compared with those receiving intraoperative administration.
  
  
  METHODS
  Medline, Embase, Current Controlled Trials and Cochrane Central were searched from their inception dates to December 2011.
  
  
  METHODS
  Randomised controlled trials of a single dose of any antibiotic comparing preoperative with intraoperative administration were selected.
  
  
  METHODS
  Trial characteristics, outcomes and quality measures, based on the Cochrane tool for risk of bias, were independently extracted. The random effect model of DerSimonian and Laird to estimate relative risks (RRs) for maternal and neonatal outcomes was used.
  
  
  RESULTS
  Six trials met the inclusion criteria, reporting on 2313 women and 2345 newborns. Preoperative administration was associated with a significant 41% reduction in the rate of endometritis compared with intraoperative administration (RR 0.59; 95% confidence interval [95% CI] 0.37-0.94; I2 0%). In the preoperative group, there were nonsignificant reductions in the rates of wound infection (RR 0.71; 95% CI 0.44-1.14; I2 0%), maternal febrile morbidity (RR 0.94; 95% CI 0.46-1.95; I2 0%), neonatal sepsis (RR 0.81; 95% CI 0.47-1.41; I2 0%), neonatal septic work-up (RR 0.93; 95% CI 0.71-1.21; I2 0%) and neonatal intensive-care unit admission (RR 0.92; 95% CI 0.65-1.28; I2 0%). There were nonsignificant increases in the rates of maternal pyelonephritis (RR 1.09; 95% CI 0.49-2.43; I2 0%) and neonatal pneumonia (RR 3.36; 95% CI 0.55-20.47; I2 0%).
  
  
  CONCLUSIONS
  Compared with intraoperative administration, preoperative antibiotics significantly reduce the rate of endometritis. The lack of neonatal adverse effects should be cautiously interpreted given the limited power of the trials to detect such effects.
authors.affiliation: College of Medicine-Jeddah, King Saud bin Abdulaziz University for Health Sciences and Department of OB/GYN, King Abdulaziz Medical City-WR, Jeddah, Saudi Arabia. baaqeelhs@ngha.med.sa
authors.forename: H
authors.initials: H
authors.lastname: Baaqeel
authors.forename: R
authors.initials: R
authors.lastname: Baaqeel
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007239:Infections / Q000188:drug therapy*; D011183:Postoperative Complications / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents