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
Citation
Master of Medicine (MMed) degree in Obstetrics & GynaecologySponsorhip
University of NairobiPublisher
Department of Obstetrics & Gynaecology University of Nairobi.