Single-dose versus multiple-dose antibiotics prophylaxis for preventing caesarean section postpartum infections: A randomized controlled trial

• Published in: Women's health (London, England) Vol. 18; p. 17455057221101071
• Main Authors: Igwemadu, Gerald Tochukwu, Eleje, George Uchenna, Eno, Enang Enang, Akunaeziri, Uche Augustine, Afolabi, Folashade Adeola, Alao, Abayomi Ibukun, Ochima, Onazi
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 2022; Sage Publications Ltd; SAGE Publishing
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis - methods; Antibiotic resistance; Antibiotics; Ceftriaxone; Cefuroxime; Cesarean section; Cesarean Section - adverse effects; Clinical trials; Disease prevention; Drug resistance; Emergency medical services; Endometritis; Endometritis - epidemiology; Endometritis - etiology; Endometritis - prevention & control; Female; Health care facilities; Humans; Infections; Intravenous administration; Metronidazole; Morbidity; Original; Patients; Postpartum Period; Pregnancy; Prophylaxis; Puerperal Infection - drug therapy; Puerperal Infection - etiology; Puerperal Infection - prevention & control; Risk groups; Statistical analysis; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; Tablets; Wound infection; postoperative; wound infections; antibiotics prophylaxis; caesarean section
• ISSN: 1745-5057; 1745-5065
• DOI: 10.1177/17455057221101071

Background:
Caesarean section, a common obstetric surgical procedure, is a major predisposing factor for puerperal infections, requiring the need for antibiotic prophylaxis. Evidence suggests that single-dose antibiotic prophylaxis has comparable efficacy to multiple-dose antibiotic prophylaxis, but with a lower cost and risk of antibiotic resistance. However, single-dose antibiotic prophylaxis after caesarean section is not generally used in many centres in sub-Saharan Africa.
Objective:
This study aimed to compare the effectiveness of single- versus multiple-dose antibiotic prophylaxis to prevent post-caesarean section infections.
Methodology:
This open-label, randomized controlled trial involved 162 consenting patients admitted for caesarean section (elective or emergency) at the Federal Medical Centre Keffi. They were distributed randomly into treatment arm A or B. Subjects in both arms received intravenous ceftriaxone (1 g) and metronidazole (500 mg) 30–60 min before incision; subjects in arm B received additional parenteral doses for 48 h and then cefuroxime 500 mg tablets every 12 h and metronidazole 400 mg tablets every 8 h for 5 days. The patients were monitored for 2 weeks for evidence of wound infection, febrile morbidity and clinical endometritis.
Result:
There was no statistical difference in the incidence of wound infection (6.6% versus 7.4%; p = .882) and febrile morbidity (11.8% versus 11.1%, p = .807). However, clinical endometritis (0.0% versus 6.1%, p = .028) was statistically significant with none reported in the single-dose arm.
Conclusion:
Single-dose ceftriaxone and metronidazole is as effective as multiple doses for antibiotic prophylaxis to prevent post-caesarean section infections. Adoption of this approach in low-risk patients would reduce the cost of prophylactic antibiotics, workload for staff and antibiotic resistance.