title: Single dose versus multiple dose of antibiotic prophylaxis in caesarean section: a systematic review and meta-analysis.
abstract: BACKGROUND
  Prophylactic antibiotics are traditionally given as a single dose for caesarean section. However, inconsistent application of recommendations and recent evidence prompted a literature review.
  
  
  OBJECTIVE
  To assess the optimal regimen for antibiotic prophylaxis in caesarean section by comparing single versus multiple doses of the same intervention.
  
  
  METHODS
  MEDLINE, Web of Knowledge, SCOPUS, CENTRAL and ongoing trials databases were searched. Reference lists were reviewed and international groups contacted.
  
  
  METHODS
  Randomised controlled trials (RCT) comparing single with multiple dose regimens of the same antibiotic prophylaxis. Quasi-RCT and abstracts were suitable for inclusion.
  
  
  METHODS
  Reviewers independently extracted data and assessed quality of evidence. A random-effects model was used and results presented as risk ratio (RR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Sixteen studies were included, involving 2695 women. Nonsignificant differences were observed between single dose and multiple dose antibiotic prophylaxis in the incidence of postpartum infectious morbidity (RR 0.95, 95% CI 0.75-1.20, I2= 25%), endometritis (RR 1.03, 95% CI 0.74-1.42, I2= 0%) and wound infection (RR 1.22, 95% CI 0.72-2.08, I2= 0%). A trend towards lower risk of urinary tract infection was seen with multiple dose (RR 0.65, 95% CI 0.34-1.24, I2= 0%).
  
  
  CONCLUSIONS
  There was insufficient evidence to determine whether there is a difference between single and multiple dose regimens in reducing the incidence of infectious morbidity after caesarean section. The quality of evidence was very low and well-designed RCTs are needed.
  
  
  CONCLUSIONS
  Insufficient evidence of difference between dosage regimens of antibiotic prophylaxis in caesarean section.
authors.affiliation: Faculty of Medicine of the University of Porto, Porto, Portugal.|Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Pinto-Lopes
authors.affiliation: Faculty of Medicine of the University of Porto, Porto, Portugal.|Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.
authors.forename: B
authors.initials: B
authors.lastname: Sousa-Pinto
authors.affiliation: Faculty of Medicine of the University of Porto, Porto, Portugal.|Department of Health Information and Decision Sciences (CIDES) of the Faculty of Medicine and Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.|Portuguese Branch of the Iberoamerican Cochrane Centre, Porto, Portugal.
authors.forename: L F
authors.initials: LF
authors.lastname: Azevedo
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002585:Cesarean Section / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; caesarean section; infectious morbidity; multiple dose; single dose