Systematic reviews of antibiotic prophylaxis in cesareans

Abstract

This study reviews the available evidence on the efficacy of antibiotic prophylaxis in cesarean sections. The study included a detailed analysis of the quality of design and performance and the clinical heterogeneity of selected clinical trials. Meta-analysis of placebo-controlled trials estimated an efficacy of some 65% for the two study endpoints, endometritis and surgical wound infection, corresponding to a decrease in infection rates of some 11% and 5%, respectively. Sensitivity analyses showed summary effects similar to those observed for all studies. Results for the non-elective cesarean sections subgroup (12 studies) indicated a relevant benefit for both endpoints, corresponding to a decrease in incidence rates of some 14% (endometritis) and 5% (surgical infection wound). For elective surgeries (two trials), no relevant benefit was found. Evidence from comparative trials on number of doses was limited due to important methodological shortcomings and to the small number of patients enrolled (three trials). Comparative drug trials (seven studies) did not show evidence of different performance between first and second-generation cephalosporins.