A randomised controlled trial of antibiotic prophylaxis in elective caesarean delivery

Objective To determine whether prophylactic antibiotic administration using cefoxitin at the time of elective caesarean section significantly reduces infectious morbidity. Setting A tertiary teaching hospital in a large urban city in South Africa. Participants Women undergoing elective caesarean section. Design A prospective, double-blind randomised placebo-controlled trial. Methods Four hundred and eighty women undergoing elective caesarean section had cefoxitin or placebo administration after umbilical cord clamping. Pos tpartum complications including febrile morbidity, wound infection, endomet ritis, urinary tract infection, pneumonia and transient postpartum fever we re recorded, as were the duration of hospital stay and the need for therape utic antibiotics. Results Wound infection was the most common complication occurring in 13.3% and 12.5% of women in the placebo and cefoxitin groups, respectively. Prop hylactic antibiotics did not decrease febrile morbidity, wound infection, e ndometritis, urinary tract infection and pneumonia. Women who received cefo xitin stayed on average a day less in hospital than those who received plac ebo (6.9 vs 7.8 days, risk difference 0.94 CI 1.57-0.31 days). Eleven women (4.6%) in the placebo group and eight (3.4%) in the cefoxitin group had mi crobiological evidence of wound infection. Staphylococcus aureus was the mo st common pathogen (43%) isolated. Similar proportions in both groups (6.3% placebo and 5.1% cefoxitin) required a course of therapeutic antibiotics. Conclusion Antibiotic prophylaxis with cefoxitin in elective caesarean sect ion did not reduce post-operative infectious morbidity in this double-blind randomised placebo controlled trial.