Short- versus long-course prophylactic antibiotic treatment in Cesarean section patients

A prospective randomized clinical trial was performed to test the effectiveness of long and short courses of antibiotic prophylaxis in avoiding morbidity after cesarean section. Eighty internally monitored laboring patients who required cesarean section were randomly assigned to one of 3 treatment groups: 1) a control group (31 patients) of those receiving no prophylactic antibiotics, 2) a short-course group (24 patients) of those receiving 24 hours of cephalosporin prophylaxis, and 3) a long-course group (25 patients) of those receiving 5 days of cephalosporin prophylaxis. Evaluation of postpartum outcome was based on the development of endometritis and /or wound infection and on the fever index. Based on the findings of no significant differences between the 3 treatment groups for 11 potential risk factors for postpartum morbidity, randomization was judged to have been successful. A significant decrease in the rate of endometritis and/or wound infection was seen in both the short- and long-course prophylactic groups as compared to the control group (29%, 20%, and 65%, respectively). There were no significant differences in postpartum morbidity between the short- and long-course prophylactic groups. Based on fever index data and individual case evaluations, there was no evidence that antibiotic prophylaxis increased the chance of more severe infection.