Caesarean section increases the risk of postpartum
infection for women and prophylactic
antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of
antibiotics to use and those with the least adverse effects.
OBJECTIVES: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014) and reference lists of retrieved papers.
SELECTION CRITERIA: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.
MAIN RESULTS: We included 35 studies of which 31 provided data on 7697 women. For the main comparison between
cephalosporins versus
penicillins, there were 30 studies of which 27 provided data on 7299 women. There was a lack of good quality data and important outcomes often included only small numbers of women.For the comparison of a single
cephalosporin versus a single
penicillin (Comparison 1 subgroup 1), we found no significant difference between these classes of
antibiotics for our chosen most important seven outcomes namely:
maternal sepsis - there were no women with
sepsis in the two studies involving 346 women; maternal
endometritis (risk ratio (RR) 1.11, 95% confidence interval (CI) 0.81 to 1.52, nine studies, 3130 women, random effects, moderate quality of the evidence); maternal
wound infection (RR 0.83, 95% CI 0.38 to 1.81, nine studies, 1497 women, random effects, low quality of the evidence), maternal
urinary tract infection (RR 1.48, 95% CI 0.89 to 2.48, seven studies, 1120 women, low quality of the evidence) and maternal composite adverse effects (RR 2.02, 95% CI 0.18 to 21.96, three studies, 1902 women, very low quality of the evidence). None of the included studies looked for infant
sepsis nor infant oral
thrush.This meant we could only conclude that the current evidence shows no overall difference between the different classes of
antibiotics in terms of reducing maternal
infections after
caesarean sections. However, none of the studies reported on
infections diagnosed after the initial postoperative
hospital stay. We were unable to assess what impact, if any, the use of different classes of
antibiotics might have on bacterial resistance.
AUTHORS' CONCLUSIONS: Based on the best currently available evidence,
cephalosporins and
penicillins have similar efficacy at
caesarean section when considering immediate postoperative
infections. We have no data for outcomes on the baby, nor on late
infections (up to 30 days) in the mother. Clinicians need to consider bacterial resistance and women's individual circumstances.