Cefazolin versus Cefazolin plus Metronidazole for Antibiotic Prophylaxis at Cesarean Section (original) (raw)
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Single vs Multiple Dose of Cefazolin Prophylaxis in Elective Cesarean Section
Indonesian Journal of Obstetrics and Gynecology, 2017
there is unavailable data of cesarean section (CS) rate. Meanwhile, there were around 1,341 CS procedure per year in Dr. Cipto Mangunkusumo hospital as the center of referral hospital in Indonesia. It meant that CS procedure covered 38% of all delivery cases. In 1999-2000, 13.9% CS was performed without medical indication. 1 Cesarean section often leads to complications, including surgical site infection (SSI), endometritis, and urinary tract infection. 2 These complications can increase the length of stay in hospital which impacts to the health expense. According to data in United States, complications after CS procedure resulted 10 days of extra care in hospital and it spent about USD 2,000 per case. 3 Meanwhile, the risk of complications after CS was different from 0.3% to almost 25.3% in Turkey. 4 Committee of Prevention and Infection Control at
Calculating the appropriate prophylactic dose of cefazolin in women undergoing cesarean delivery
The Journal of Maternal-Fetal & Neonatal Medicine, 2020
Background and Objectives: Surgical site infection and other postoperative complications are relatively common in obstetrical procedures, and they are associated with morbidity, prolonged hospital stay, and readmissions. Appropriate levels of antimicrobial agents given directly before skin incision can prevent the establishment of surgical-related infection caused by endogenous microorganisms present on the woman's skin. We aimed to determine serum concentrations of cefazolin given to pregnant women prior to scheduled cesarean delivery and to compare their drug concentrations and pharmacokinetics in 2 weight groups. Study Design: We conducted a prospective cohort analysis of the pharmacokinetics of cefazolin in women undergoing cesarean delivery (August 2017 to September 2018). One or two grams of intravenous cefazolin was administered within 30 min prior to skin incision to women weighing <80 kg and !80 kg, respectively. Maternal serum samples were obtained at skin incision and 30 min later. The serum concentration of cefazolin was measured by high-pressure liquid chromatography. Antimicrobial coverage was defined as being appropriate when the cefazolin levels were above the minimal inhibitory concentration. Pharmacokinetic parameters were estimated using a one-compartment model. Results: A total of 61 women were enrolled, of whom 47 underwent cesarean delivery (study group). The mean time that had elapsed between drug administration to incision was 13 ± 6.9 min (95% confidence interval 10.6-16.2 min). The drug levels after 30 min in women who weighed >80 kg and in women who received 2 g cefazolin, after 30 min from incision differed significantly (87.0 ± 26.0 vs 55.4 ± 16.6 lg/ml, p ¼ .0001). Conclusion: A single 1-or 2-g dose of cefazolin provides serum concentrations above minimal inhibitory concentrations for susceptible pathogens in most women undergoing scheduled cesarean delivery.
The routine use of cefazolin in cesarean section
International Journal of Gynecology & Obstetrics, 2000
Objecti¨e: To determine the effectiveness and safety of the routine use of antibiotic prophylaxis in women undergoing cesarean section. Method: Four hundred and forty-one women undergoing cesarean sections were randomly assigned either to a single dose of 1 g intravenous cefazolin or placebo after clamping of the umbilical cord. The primary outcome was the development of post-operative febrile morbidity and the secondary outcomes were infection-related complications. Result: There were 211 emergency and 230 elective cesarean sections. In the Ž . emergency cesarean sections, 34 30.6% women developed post-operative febrile morbidity in the placebo group Ž . Ž . compared to 11 11% women in the cefazolin group. This was a statistically significant difference P s 0.001 . Similarly, there were statistically significant differences between the two groups in the development of wound Ž . Ž . Ž . infection P-0.001 , use of therapeutic antibiotics P s 0.001 , and post-operative days in hospital Ps 0.003 . No statistically significant differences were detected in the development of other infection-related complications. In the elective cesarean sections, no statistically significant differences were found in post-operative febrile morbidity and infection-related complications. There were no serious side effects related to the use of cefazolin. Conclusion: The routine use of a single dose of cefazolin is safe and effective in emergency but not elective cesarean section. ᮊ 2000 International Federation of Gynecology and Obstetrics.
Journal of Pelvic Medicine and Surgery, 2007
Objectives: Antibiotic prophylaxis of surgical site infections after urgent cesarean section is justified by the reduction of endometritis by two-thirds to three-quarters and a decrease in wound infections. However, not all antibiotics show adequate protection. In our study, we compared pharmacokinetic profiles of 3 commonly used antibiotics for prophylaxis: cefazolin, cefuroxime, and ceftriaxone. Methods: A total of 60 patients were enrolled in the study, divided in 3 groups, each receiving different antibiotic. Two gm cefazolin, 1.5 gm cefuroxime, or 2 gm ceftriaxone were administered in 1 intravenous dose, immediately after clamping the umbilical cord. Results: Only concentrations of cefazolin measured in serum from the cubital vein and uterine cavum samples were above minimal inhibitory concentrations of all susceptible common pathogens for the whole intraoperative period. Cefazolin concentrations in blood from the uterine cavum were even higher than concentrations measured in blood from the cubital vein in the same time (10 minutes after intravenous injection): 89.0 mg/L versus 78.2 mg/L. Conclusions: The results of our study suggest a more suitable pharmacokinetic profile of cefazolin than that of cefuroxime and ceftriaxone for prophylaxis of surgical site infections after urgent cesarean section.
Kathmandu University Medical Journal, 1970
Background: Puerperal sepsis is frequently in Caesarean section. Antibiotic prophylaxis may have signifi cant impact in reduction of infections and thus the need to study its role in sepsis prevention systematically. Objective: The aim of this study is to compare the effi cacy of single dose versus multiple doses of a fi rst generation cephalosporin (with Metronidazole), to reduce postoperative infectious morbidity in elective caesarean section. Materials and methods: It was prospective clinical trial of hundred women undergoing elective caesarean section who received either a single prophylactic dose of Cefazolin with Metronidazole post-cord clamping, or multiple postoperative doses of antibiotics based on the standard protocol of the hospital. Duration of the study was seven months and twentytwo days (11 th November 2004 to 30 th June 2005).Women were compared on the basis of development of postoperative febrile morbidity, endometritis, urinary tract infection, wound infection and other infections. Results: There were no signifi cant differences among the patients in single and multiple dose groups in terms of their age distribution, gravida, period of gestation, smoking status, body mass index, indications for elective caesarean section or operation characteristics. There were 4% and 6% febrile morbidity, 2 (4%) and 0 (0%) urinary tract infection, in the single dose and multiple dose groups respectively. But none of the differences were statistically signifi cant. Conclusion: A single prophylactic dose of Cefazolin plus Metronidazole given post-umbilical cord clamping gives as much protection as multiple postoperative doses of Cefazolin/Cefalexin plus Metronidazole in preventing postoperative infectious morbidity in elective caesarean section.
Successful control program to implement the appropriate antibiotic prophylaxis for cesarean section
Revista do Instituto de Medicina Tropical de São Paulo, 2008
OBJECTIVE: Describe implementation of a successful program to reduce doses (cefazolin 2 to 1 g) used for antimicrobial prophylaxis. METHODS: Evaluation of an intervention program to reduce prophylactic antimicrobial doses. The intervention included weekly staff discussions, automatic dispensation of 1g-vial of cefazolin by the pharmacy unless expressly requested by surgeon and increase in post-discharge surveillance as a strategy to reassure surgeons of the safety of the reduction. In the pre and post intervention periods, a prospective study of antimicrobial consumption and surgical site infections were measured. RESULTS: There were 5,164 and 5,204 deliveries in 2001-2002 and 2003-2004, respectively; 1,524 (29.5%) and 1,363 (26%) were cesarean sections. There was a 45% decrease in cefazolin vials used on average per cesarean section (2.29 to 1.25). Patients evaluated increased from 16% to 67% and the SSI rates in both periods were 3.34% to 2.42%, respectively. CONCLUSION: An ample ...
Pharmacy World & Science, 2010
To identify changes in prescribing patterns of antibiotic prophylaxis in caesarean delivery after introduction of local clinical guidelines. To identify changes in outcomes of prescribing antibiotics following the implementation of local clinical guidelines on antibiotic prophylaxis. University of Belgrade, Medical School, Clinic of Gynaecology and Obstetrics &amp;amp;amp;quot;Narodni front&amp;amp;amp;quot; Belgrade, Serbia. A quantitative retrospective analysis of antibiotic use before (January-June 2005), and following (January-June 2006) implementation of guidelines on antibiotic prophylaxis in two wards. Patients who underwent caesarean section prior to (261) and following (281) introduction of local guidelines, participated in this study. Drug utilization cost presented as the number of DDD/100 bed days/eur, the average duration of hospital stay, number of wound infections. There was a significant change in prescribing patterns of antibiotic prophylaxis in caesarean section following introduction of local guidelines. The use of ceftriaxone, amikacin and metronidazole decreased (57.47% vs. 11.74%; 9.19% vs. 4.27%; 61.69% vs. 46.26%, respectively). On the other hand, the use of &amp;amp;amp;quot;older&amp;amp;amp;quot; antibiotics such as gentamicin, cefuroxime, cefazolin and ampicillin increased (14.56% vs. 29.18%; 9.2% vs. 17.44%; 9.58% vs. 45.2% and 0% vs. 3.9%, respectively). DDD/100 bed days/eur analysis revealed a 47% decrease of total cost for prophylactic antibiotic treatment in caesarean section following local guideline implementation. In contrast, rate of wound infections and duration of hospital stay were not significantly different in both groups. In an attempt to ensure cost-effective prophylactic use of antibiotics in caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of &amp;amp;amp;#39;third&amp;amp;amp;#39; generation of cephalosporin&amp;amp;amp;#39;s whereas the use of &amp;amp;amp;quot;older&amp;amp;amp;quot; antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.