Antibiotic prophylaxis in elective caesarean section: single dose Compared to multiple dose antibiotics: a randomized clinical trial

Abstract

Backqround The benefit of antibiotic prophylaxis in both emergency and elective caesarean section has been demonstrated repeatedly in studies, mostly in western countries. Most of these studies have not demonstrated significant differences between single and multiple dosing regimens. Single dose regimens are not generally used in Kenyatta National hospital and other public institutions. Objective: To compare the incidence of any puerperal infections among women receiving a single high dose Crystalline penicillin plus Gentamicin intra-operatively with those receiving a three day regular dose Crystalline penicillin plus Gentamicin as prophylaxis during elective caesarean section at Kenyatta National Hospital. Study DesigJ!.:This was a Randomized, Double-blinded Clinical Trial Studv Area: The study was conducted at Kenyatta National Hospital, Nairobi, Kenya. Study population: The study population constituted women admitted at Kenyatta National Hospital for elective Caesarean section. Outcome measures: These were post-partum fever, surgical site (wound) infection and clinical endometritis. Results: 75 questionnaires were administered but only 72 were analysed (36 for each arm of the study). There were no significant differences in the sociodemographic characteristics, pre-operative obstetric characteristics and laboratory profiles. There were also no significant differences in the postoperative clinical indicators of puerperal infection, which were fever (p=l), wound infection, uterine tenderness (p=O.396), uterine sub-involution (p=O.164) and the colour (p=O.543) and smell of lochia. Fever was the only recorded clinical indicator of infection, though this did not meet the criteria specified for post-partum febrile illness. 10 Conclusion and recommendation: A single high-dose of Crystalline penicillin and gentamicin is as effective as multiple regular-dose Crystalline penicillin and gentamicin as prophylaxis against puerperal infection in women undergoing elective caesarean section. It is therefore recommended