A RANDOMIZED TRIAL OF PENICILLIN AND STREPTOMYCIN IN THE PREVENTION OF POSTPARTUM INFECTION IN UGANDA

We report findings of a randomized trial of penicillin and streptomyci n to prevent post-partum infection conducted on 737 women who delivere d consecutively at Kawempe Maternity Centre (KMC) in Kampala from 1st October, 1989 to 31st May, 1990. The objectives were: (i) to identify clinical post-partum infection using at least two of its symptoms and signs (fever, lower abdominal pain, lower abdominal tenderness, vagina l discharge); (ii) to identify the causes of post-partum infection usi ng laboratory methods; and (iii) evaluate the effectiveness of prophyl actic fortified procaine penicillin (PPF) and streptomycin on post-par tum infection. Clinical infection occurred in 36.4% of the group not g iven antibiotics, 23.3% in the PPF group and 20.3% in the streptomycin group. Laboratory-confirmed infection occurred in 15.5% of the group not given antibiotics, 9.2% in the PPF group and 8.4% in the streptomy cin group. However, severe laboratory-confirmed infection (severe clin ical infection plus positive laboratory findings) occurred in 4.9% of the group not given antibiotics, 6.1% in the PPF group and 6.6% in the streptomycin group. In general, the organisms isolated included enter obacteria (35.9%), yeast and protozoa (31.6%), staphylococci (23.9%), streptococci (69%) and Neisseria (1.7%). The advantage of PPF and stre ptomycin was evident in most subgroups defined by clinical characteris tics or laboratory findings. In view of the findings in this study, we believe that prophylactic antibiotics given in labor may have a role to play at reducing the incidence of post-partum infection. However, a s the cost of antibiotics in developing countries is significant, the development of resistant organisms due to indiscriminate antibiotic us e is also a concern and health resources are best used when targeted a t specific populations, we feel that antibiotic prophylaxis should not be used routinely and that a more realistic view can be obtained by s tudying high-risk groups of women with more severe infection.