Prophylactic Antibiotics at Cesarean Delivery: Extended Postoperative Regimen Versus Single Preoperative Dose
Keywords:
Cesarean section, surgical site infection, antibiotic prophylaxis, extended regimen, endometritisAbstract
Introduction: Preoperative antibiotics for cesarean delivery reduce surgical site infections (SSI). Extended postoperative prophylaxis is common but may contribute to antimicrobial resistance.
Methods: Meta-analysis of randomized controlled trials comparing single preoperative dose versus continued postoperative antibiotics (≥24 hours). Primary outcome: SSI (superficial or deep). Secondary: endometritis, neonatal outcomes.
Results: Fourteen trials (n=12,500 women) were included. Baseline SSI rate with single dose was 6.5%. Extended prophylaxis reduced SSI to 4.8% (risk ratio 0.74, number needed to treat 58). Endometritis reduction was similar. No differences in neonatal sepsis, diarrhea, or fungal infections were found. Extended regimens varied widely.
Discussion: The absolute risk reduction is small (1.7%), and the number needed to treat is high. Extended prophylaxis may benefit high-risk populations (obesity, prolonged rupture). Routine use risks increasing resistant organisms.
Conclusions: Routine extended postoperative antibiotics after cesarean delivery provide only a marginal SSI reduction. They should be reserved for women with additional risk factors rather than universally applied.
