Ampicillin/sulbactam versus ampicillin alone for cesarean section prophylaxis: a randomized double-blind trial

Area of Science:

• Obstetrics and Gynecology
• Infectious Disease Prevention
• Surgical Site Infections

Background:

• Postpartum endometritis is a common complication following cesarean sections.
• Antibiotic prophylaxis is standard for cesarean deliveries, particularly with ruptured membranes.
• The effectiveness of specific antibiotic regimens requires ongoing evaluation.

Purpose of the Study:

• To compare the efficacy of ampicillin alone versus ampicillin with sulbactam for preventing postpartum endometritis.
• To assess the impact of ruptured membranes on antibiotic prophylaxis effectiveness.
• To evaluate anaerobic coverage in preventing endometritis after nonelective cesarean sections.

Main Methods:

• A randomized, prospective, double-blind study was conducted.
• Ninety-four women undergoing nonelective cesarean sections received either ampicillin alone (45 patients) or ampicillin plus sulbactam (46 patients).
• Patients were stratified based on the presence or absence of ruptured membranes; 75% had ruptured membranes.

Main Results:

• Postpartum endometritis occurred in 8.8% of patients receiving ampicillin and sulbactam.
• In contrast, 35.3% of patients receiving ampicillin alone developed endometritis.
• This difference was statistically significant (p < 0.02), indicating superior prophylaxis with the combination therapy.

Conclusions:

• Single-dose ampicillin and sulbactam offers superior prophylaxis against postpartum endometritis compared to single-dose ampicillin.
• The combination therapy is particularly beneficial for women undergoing cesarean section with ruptured membranes.
• This study supports the use of ampicillin and sulbactam for enhanced anaerobic coverage in preventing postpartum infections.