Comparative study on post-partum infection among women using single dose and multiple dose antibiotic prophylaxis during elective caesarean delivery: a randomized controlled trial

Abstract

Background: Large Cochrane reviews have demonstrated that single dose antibiotic prophylaxis during caesarean section is adequate in reducing the risk for postpartum infection. Most of the work has been done in the west where the risk factors for developing sepsis could be different from those in our setup because of intensive screening for infection in the antenatal period and difference in the population. The purpose of this. study was to assess the adequacy of the recommended dosage for antibiotic prophylaxis during caesarean section in our population. Objective: To compare the incidence of puerperal infections among elective caesarean section patients who receive intraoperative stat dose of intravenous ampicillin, gentamicin and metronidazole prophylaxis with three additional doses post operatively at Nazareth Hospital. Study Design: A randomised controlled trial. Setting: Nazareth Mission Hospital, Kiambu, Central Province. Results: A total of 75 questionnaires were analysed, 42 in the single dose (SO) and 33 in the multiple dose (MD) group. Study baseline sociodemographic and obstetric characteristics, indications for caesarean section and haematological studies were similar in the two groups. Day 4 postoperative assessment of clinical and laboratory indications for sepsts demonstrated no difference. These were state of wound, lochia charcteristics, temperature, white blood cell count and erythrocyte sedimentation rate. High prevalence of resistance to augrnentin and gentamicin was demonstrated, 100% resistance to augmentin for E. Coli, Staphylococcus, Pseudomonas and Klebsiella and 100% resistance to gentamicin for E. Coli and Klebsiella. Proteus and Pseudomonas were sensitive to gentamicin Conclusion: Stat dose broad spectrum antibiotics with intravenous ampicillin, gentamicin and metronidazole is adequate prophylaxis against postpartum infection In women undergoing elective caesarean section. Recommendation: Use of single dose antibiotic prophylaxis with intravenous ampicillin, gentamicin and metronidazole during elective caesarean delivery and regular institution assessment of antimicrobial resistance pattern