First-generation cephalosporins (commonly, 1 g of cefazolin) remain the antibiotic of choice, but the combination of clindamycin and gentamicin was suggested as an acceptable alternative for women who are allergic to penicillin.
ACOG reviewed studies by Thigpen and colleagues and Sullivan and coworkers, as well as a meta-analysis by Costantine and associates.2-4 The relatively small size of these studies and the mixed results of other studies point to the need for further investigation, a fact acknowledged by ACOG. Nevertheless, the committee concluded that “preoperative administration significantly reduces endometritis and total maternal infectious morbidity, compared with administration of antimicrobials after umbilical cord clamping.”
WHAT THIS EVIDENCE MEANS FOR PRACTICE
Antimicrobial prophylaxis for surgical-site infection is a well-established practice for both obstetric and gynecologic surgery. Cesarean delivery accounts for one third (more than 1.3 million) of all births in the United States each year and carries a risk of infection at least five times higher than that associated with vaginal delivery. Given the rising incidence of cesarean delivery in the United States and elsewhere, the prevention of postcesarean infection is a priority.
This ACOG Committee Opinion should prompt providers who continue to administer antibiotics after cord clamping to reevaluate the practice.
Even so, given the relative paucity of randomized trials addressing this issue and the mixed results from individual studies, it is essential that we continue to monitor the effectiveness and safety of pre-incision prophylaxis.
Larger follow-up studies to further evaluate resistance profiles and the effects of pre-incision administration on the newborn should be undertaken in concert with implementation of this recommendation.
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