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Updated: Apr 23, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a
Esther H M N Westen1, Pascal R Kolk, Christine L van Velzen
1Mkomaindo District Hospital, Masasi, Tanzania; Department of Obstetrics and Gynecology, Máxima Medical Center, Veldhoven, the Netherlands.
Objective:
To investigate the efficacy of a single prophylactic dose of ampicillin combined with metronidazole to prevent postcesarean section infections compared with a multiple day regimen in low-resource settings.
Design:
An evaluator-blinded randomized, controlled, noninferiority trial.
Setting:
Two rural hospitals in Tanzania.
Population:
Of 181 enrolled eligible women with an indication for cesarean section, information on 176 was analyzed by intention-to-treat.
Methods:
The women were randomly assigned to either the intervention group who received a single dose of ampicillin and metronidazole, or to the control group who received a multiple-day regimen of ampicillin/amoxicillin and metronidazole.
Main Outcome Measures:
The primary outcome was maternal postcesarean infection. Secondary outcomes were severity of these infections, other maternal complications, and the duration of hospital stay.
Results:
In the intervention group (n = 89), six women (6.7%) developed a wound infection compared with nine (10.3%) in the control group (n = 87) (difference 3.60; 95% CI -4.65 to 11.85) (p = 0.40).
Conclusions:
A single dose of prophylactic ampicillin and metronidazole is equally effective as a multiple-day regimen in preventing postcesarean wound infections in low-resource settings, therefore it can be considered as a good strategy in low-resource settings. The reduced quantity of prophylactic antibiotics will reduce costs without increasing the risk of maternal infection.
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