title: Treatment Utility of Postpartum Antibiotics in Chorioamnionitis Study.
abstract: Objective To determine if postpartum antibiotics are necessary for patients with chorioamnionitis after a cesarean delivery (CD). Study Design Multicenter randomized controlled trial. Laboring patients with singleton gestations and chorioamnionitis who underwent CD were eligible. Patients were treated with ampicillin and gentamicin per standard protocol, then given clindamycin prior to skin incision. Patients were randomized to either postpartum antibiotic prophylaxis or no treatment following delivery. The primary outcome was the rate of endometritis. Assuming a 30% risk of endometritis in patients with chorioamnionitis who undergo CD, 119 patients per arm would be required to detect a 50% decrease in endometritis. Results The trial was stopped for futility following a planned interim analysis after 80 patients were randomized. There was no difference in the rate of the primary outcome between the two groups (9.8 vs. 7.7%, relative risk [RR]: 1.27; 95% confidence interval [CI]: 0.30, 5.31). A meta-analysis comparing post-CD antibiotics versus no treatment did not find a statistically significant difference between the groups (16.7 vs. 12.0%, pooled RR: 1.43; 95% CI: 0.72, 2.84). Conclusion Additional postpartum antibiotics do not decrease the rate of endometritis in patients with chorioamnionitis who undergo CD. The current preoperative antibiotic regimen including clindamycin should remain the standard of care in these patients.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Shanks
authors.affiliation: Department of Obstetrics and Gynecology, Saint Louis University, Saint Louis, Missouri.
authors.forename: Suwan
authors.initials: S
authors.lastname: Mehra
authors.affiliation: Department of Obstetrics and Gynecology, Saint Louis University, Saint Louis, Missouri.
authors.forename: Gil
authors.initials: G
authors.lastname: Gross
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Ryan
authors.initials: R
authors.lastname: Colvin
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Lorie M
authors.initials: LM
authors.lastname: Harper
authors.affiliation: Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
authors.forename: Methodius G
authors.initials: MG
authors.lastname: Tuuli
mesh_terms: D000293:Adolescent; D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002585:Cesarean Section / Q000009:adverse effects*; D002821:Chorioamnionitis / Q000188:drug therapy*; D002981:Clindamycin / Q000627:therapeutic use; D004716:Endometritis / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D018447:Medical Futility; D015201:Meta-Analysis as Topic; D008923:Missouri; D049590:Postpartum Period; D011247:Pregnancy; D055815:Young Adult
chemical_list: D005839:Gentamicins; D002981:Clindamycin; D000667:Ampicillin