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Single dose versus multiple dose of antibiotic prophylaxis in caesarean section: a systematic review and

R Pinto-Lopes1,2, B Sousa-Pinto1,2, L F Azevedo1,2,3

  • 1Faculty of Medicine of the University of Porto, Porto, Portugal.

BJOG : an International Journal of Obstetrics and Gynaecology
|November 26, 2016
PubMed

Insights

Current evidence is insufficient to determine if single or multiple doses of prophylactic antibiotics are superior for caesarean sections. More high-quality randomized controlled trials are needed to clarify optimal antibiotic regimens.

Area of Science:

  • Obstetrics and Gynecology
  • Infectious Disease Prevention
  • Pharmacology

Background:

  • Antibiotic prophylaxis is standard for caesarean sections, typically a single dose.
  • Inconsistent adherence to guidelines and emerging data necessitate a review of optimal antibiotic regimens.
  • This review evaluates single versus multiple doses of prophylactic antibiotics for caesarean delivery.

Purpose of the Study:

  • To compare the efficacy of single-dose versus multiple-dose antibiotic prophylaxis in preventing postpartum infectious morbidity after caesarean section.
  • To assess the impact of different prophylactic antibiotic dosing strategies on endometritis, wound infection, and urinary tract infection rates.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases (MEDLINE, Web of Knowledge, SCOPUS, CENTRAL) and ongoing trials.
  • Randomized controlled trials (RCTs) and quasi-RCTs comparing single with multiple doses of the same antibiotic prophylaxis were included.
  • Data were independently extracted, evidence quality assessed, and a random-effects model used to calculate risk ratios (RR) with 95% confidence intervals (CI).

Main Results:

  • Sixteen studies involving 2695 women were analyzed.
  • No significant differences were found in postpartum infectious morbidity (RR 0.95, 95% CI 0.75-1.20), endometritis (RR 1.03, 95% CI 0.74-1.42), or wound infection (RR 1.22, 95% CI 0.72-2.08) between single and multiple doses.
  • A trend suggested a lower risk of urinary tract infection with multiple doses (RR 0.65, 95% CI 0.34-1.24).

Conclusions:

  • There is insufficient evidence to definitively conclude whether single or multiple doses of prophylactic antibiotics are more effective after caesarean section.
  • The overall quality of the evidence reviewed was very low.
  • Well-designed randomized controlled trials are required to establish optimal antibiotic prophylaxis regimens for caesarean delivery.
Abstract

Keywords:
Antibiotic prophylaxiscaesarean sectioninfectious morbiditymultiple dosesingle dose

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