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Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, noninferiority trial

Acta obstetricia et gynecologica Scandinavica, 2015-01, Vol.94 (1), p.43-49 [Peer Reviewed Journal]

2014 Nordic Federation of Societies of Obstetrics and Gynecology ;2014 Nordic Federation of Societies of Obstetrics and Gynecology. ;Acta Obstetricia et Gynecologica Scandinavica © 2015 Nordic Federation of Societies of Obstetrics and Gynecology ;ISSN: 0001-6349 ;EISSN: 1600-0412 ;DOI: 10.1111/aogs.12517 ;PMID: 25263498 ;CODEN: AOGSAE

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Title:
Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, noninferiority trial
Author: Westen, Esther H.M.N. ; Kolk, Pascal R. ; van Velzen, Christine L. ; Unkels, Regine ; Mmuni, Nicholaus S. ; Hamisi, Alex D. ; Nakua, Ritha E. ; Vlek, Anne L.M. ; van Beekhuizen, Heleen J.
Subjects: Adolescent ; Adult ; ampicillin ; Ampicillin - administration & dosage ; Antibiotic prophylaxis ; Antibiotic Prophylaxis - methods ; cesarean section ; Cesarean Section - adverse effects ; Cesarean Section - methods ; Confidence Intervals ; Developing Countries ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Humans ; infection ; Logistic Models ; low-resource setting ; maternal morbidity ; metronidazole ; Metronidazole - administration & dosage ; Pregnancy ; Pregnancy Outcome ; Risk Assessment ; Single-Blind Method ; Socioeconomic Factors ; Statistics, Nonparametric ; Surgical Wound Infection - drug therapy ; Surgical Wound Infection - prevention & control ; Tanzania ; Treatment Outcome ; Young Adult
Is Part Of: Acta obstetricia et gynecologica Scandinavica, 2015-01, Vol.94 (1), p.43-49
Description: Objective To investigate the efficacy of a single prophylactic dose of ampicillin combined with metronidazole to prevent postcesarean section infections compared with a multiple day regimen in low‐resource settings. Design An evaluator‐blinded randomized, controlled, noninferiority trial. Setting Two rural hospitals in Tanzania. Population Of 181 enrolled eligible women with an indication for cesarean section, information on 176 was analyzed by intention‐to‐treat. Methods The women were randomly assigned to either the intervention group who received a single dose of ampicillin and metronidazole, or to the control group who received a multiple‐day regimen of ampicillin/amoxicillin and metronidazole. Main outcome measures The primary outcome was maternal postcesarean infection. Secondary outcomes were severity of these infections, other maternal complications, and the duration of hospital stay. Results In the intervention group (n = 89), six women (6.7%) developed a wound infection compared with nine (10.3%) in the control group (n = 87) (difference 3.60; 95% CI −4.65 to 11.85) (p = 0.40). Conclusions A single dose of prophylactic ampicillin and metronidazole is equally effective as a multiple‐day regimen in preventing postcesarean wound infections in low‐resource settings, therefore it can be considered as a good strategy in low‐resource settings. The reduced quantity of prophylactic antibiotics will reduce costs without increasing the risk of maternal infection.
Publisher: United States: Blackwell Publishing Ltd
Language: English;French;German
Identifier: ISSN: 0001-6349
EISSN: 1600-0412
DOI: 10.1111/aogs.12517
PMID: 25263498
CODEN: AOGSAE
Source: Journals@Ovid Open Access Journal Collection Rolling
MEDLINE
Alma/SFX Local Collection

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Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, noninferiority trial

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