Ampicillin/sulbactam versus cefuroxime as antimicrobial prophylaxis for cesarean
delivery: a randomized study.
Author(s): Ziogos E, Tsiodras S, Matalliotakis I, Giamarellou H, Kanellakopoulou K.
Affiliation(s): Department of Obtsterics and Gynecology, University General Hospital of
Heraclion, Heracleion, Greece.
Publication date & source: 2010, BMC Infect Dis. , 10:341
BACKGROUND: The efficacy and safety of a single dose of ampicillin/sulbactam
compared to a single dose of cefuroxime at cord clamp for prevention of
post-cesarean infectious morbidity has not been assessed.
METHODS: Women scheduled for cesarean delivery were randomized to receive a
single dose of either 3 g of ampicillin-sulbactam or 1.5 g of cefuroxime
intravenously, after umbilical cord clamping. An evaluation for development of
postoperative infections and risk factor analysis was performed.
RESULTS: One hundred and seventy-six patients (median age 28 yrs, IQR: 24-32)
were enrolled in the study during the period July 2004-July 2005. Eighty-five
(48.3%) received cefuroxime prophylaxis and 91 (51.7%) ampicillin/sulbactam.
Postoperative infection developed in 5 of 86 (5.9%) patients that received
cefuroxime compared to 8 of 91 (8.8%) patients that received ampicillin/sulbactam
(p=0.6). In univariate analyses 6 or more vaginal examinations prior to the
operation (p=0.004), membrane rupture for more than 6 hours (p=0.08) and blood
loss greater than 500 ml (p=0.018) were associated with developing a
postoperative surgical site infection (SSI). In logistic regression having 6 or
more vaginal examinations was the most significant risk factor for a
postoperative SSI (OR 6.8, 95% CI: 1.4-33.4, p=0.019). Regular prenatal follow-up
was associated with a protective effect (OR 0.04, 95% CI: 0.005-0.36, p=0.004).
CONCLUSIONS: Ampicillin/sulbactam was as safe and effective as cefuroxime when
administered for the prevention of infections following cesarean delivery.
TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01138852.
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