[Is antibiotic prophylaxis in Cesarean section necessary?]

A Cochrane Review from October 1998 recommends prophylactic antibiotics for all women undergoing elective and non-elective caesarean section. This is expected to reduce the frequency of postoperative endometritis by two thirds to three quarters. In this study we evaluate the infection rate after caesarean section in a hospital where prophylactic antibiotics are given only to high-risk groups.

Case records of 344 patient delivered by caesarean section were studied. 30 days after the operation, 83% answered a questionnaire about wound infection.

In all, 39% received prophylactic antibiotics. 33 patients (9.6%) developed post-cesarean infections; only 17 were given antibiotic treatment. One patient had endometritis. There were no significant differences with regard to infections between the elective and the non-elective groups (p = 0.63), or between those receiving and those not receiving antibiotic prophylaxis (p = 0.84).

The policy of selective use of prophylactic antibiotics for caesarean sections has been successful in our hospital. This study does not permit conclusions as to whether selective prophylactics is a better alternative than routine prophylactics, but the results question whether the recommendation in the Cochrane Review is the best choice for all delivery units.