Elective caesarean section; short antibiotic prophylaxis versus prolonged antibiotic therapy

To compare short antibiotic prophylaxis versus prolonged antibiotic regime in terms of morbidity control of infection in patients undergoing elective caesarean section. It was a experimental study done in Gynae/Obs unit I Holy Family Hospital Rawalpindi over a period of one year. Total of 200 patients selected randomly were admitted in antenatal ward for elective caesarean section. All these booked patients with age less then 40 years, gestational age of > 38 weeks, Hb >10g/dl, with no signs of genitourinary or respiratory tract infection were included in the study. These patients were divided in two groups with 100 patients in each group. In group I, short antibiotic prophylaxis in form of three doses of injectable antibiotic was given. In group II prolonged antibiotic regime was given as 5 days course. Augmentin was chosen as it has proven efficacy and good coverage for microorganisms of urogential tract and skin. Injection Augmentin was given in dose of 1.2g [1g Amoxycillin + 200mg clavulanic acid] I/V x BD. All operation were performed by transverse lower segment caesarean section by registrars and consultants. Anaesthesia used was mostly spinal and more than 80% of the patients were having body mass index of <30. These patients were followed in postnatal ward for post operative infectious morbidity till discharge. Data collected through proformas was entered in computer and analyzed using SPSS. Over all post operative infectious morbidity in group I was 29% and in group II30% [p = 0.877]. Post operative fever in group I was 09% and group II 08% [p = 0.800], while frequency of endometritis was found to be same in both groups which was 03%. No case of chest infection was recorded in both groups. Only 5% patients in group I and 4% patients in group II were reported to have urinary tract infection [p = 0.733]. The most common complication found during study was wound infection, the rate being 12% in group I and 15% in group II [p = 0.535]. So the overall results showed no statistically significant difference between two groups. Short antibiotic prophylaxis is as effective as prolonged antibiotic regimen. As it is cost effective and most of our patients come from low socio economic class, so this short antibiotic prophylaxis should be recommended routinely for all elective caesarean sections