title: Prophylactic ampicillin versus cefazolin for the prevention of post-cesarean infectious morbidity in Rwanda.
abstract: OBJECTIVE
  To evaluate the efficacy of ampicillin versus cefazolin as prophylactic antibiotics prior to cesarean delivery in Rwanda.
  
  
  METHODS
  In a prospective, randomized, open-label, single-site study conducted between March and May 2012, the effects of prophylactic ampicillin versus cefazolin were compared among women undergoing cesarean delivery at the Centre Hospitalier Universitaire de Kigali, Rwanda. Postoperatively, participants were evaluated daily for infectious morbidity while in the hospital. Follow-up was done by phone and by appointment at the hospital within 2 weeks of delivery.
  
  
  RESULTS
  During the study period, there were 578 total deliveries and 234 cesarean deliveries (40.4%). Overall, 132 women were enrolled in the study and randomized to receive either ampicillin (n=66) or cefazolin (n=66). No women were lost to follow-up. The overall infection rate was 15.9% (21/132). The infection rate in the ampicillin group and the cefazolin group was 25.8% (17/66) and 6.1% (4/66), respectively.
  
  
  CONCLUSIONS
  Implementing a universal protocol in Rwanda of prophylactic cefazolin prior to cesarean delivery might reduce postoperative febrile morbidity, use of postoperative antibiotics, and number of postoperative days in hospital.
authors.affiliation: Department of Obstetrics and Gynecology, National University of Rwanda Faculty of Medicine, Kigali, Rwanda; Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Kigali (CHUK), Kigali, Rwanda.
authors.forename: Victor N
authors.initials: VN
authors.lastname: Mivumbi
authors.affiliation: Department of Obstetrics and Gynecology, Harvard Medical School, Boston, USA; Department of Obstetrics and Gynecology, Brigham and Women's Faulkner Hospitals, Boston, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Little
authors.affiliation: Department of Obstetrics and Gynecology, National University of Rwanda Faculty of Medicine, Kigali, Rwanda; Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Kigali (CHUK), Kigali, Rwanda.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rulisa
authors.affiliation: Department of Obstetrics and Gynecology, Harvard Medical School, Boston, USA; Department of Obstetrics and Gynecology, Brigham and Women's Faulkner Hospitals, Boston, USA. Electronic address: jagreenberg@partners.org.
authors.forename: James A
authors.initials: JA
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D002437:Cefazolin / Q000627:therapeutic use*; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D005334:Fever / Q000209:etiology / Q000517:prevention & control; D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies; D012432:Rwanda; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000667:Ampicillin; D002437:Cefazolin
keywords: Ampicillin; Cefazolin; Cesarean; Infection; Prophylactic antibiotics; Rwanda