Comparison of short vs. Long half-life single-dose prophylactic antibiotics for cesarean section

Numerous studies demonstrate the efficacy of antibiotic prophylaxis for reducing postcesarean section infectious morbidity. The duration of therapy, however, remains controversial. Cost containment measures and the ease of single dosing have led to the introduction of "extended" half-life agents for cesarean-section chemoprophylaxis. We tested the hypothesis that there was no difference in efficacy between a single dose of a short half-life agent (cefoxitin) and a longer half-life agent (cefotetan).

A prospective, double-blind trial of 375 non-elective cesarean-section cases was carried out. Study antibiotics (2 g) were administered intravenously (IV) at cord clamping only.

Demographic and clinical variables between the 2 study groups were similar. No significant differences were noted in major or minor morbidity or in infectious morbidities for patients receiving the 2 prophylactic regimens. The occurrence of postoperative endometritis was likewise similar for the subjects receiving cefoxitin (10%) and cefotetan (15%). When cases whose surgery lasted >60 min were evaluated separately, no differences in outcomes between the 2 groups were identified.

These findings confirm our hypothesis that the half-life difference between these 2 agents does not impact on single-dose Prophylactic efficacy in cesarean section.