| dc.description.abstract | Introduction
Infection is one of the major complications of surgery. Caesarean section is the single most important risk factor for postnatal infections [2]. Prophylactic antibiotics have become a standard of management for people undergoing surgery. According to the EDLIZ 2006, women undergoing caesarean section should be given a single dose of Benzyl penicillin 5MU iv and Chloramphenicol 1gram iv. However at Parirenyatwa and Harare hospitals, patients get antibiotics for an average of 7days. The prolonged course which is in practice increases the work load on the hospital staff which is already overwhelmed due to understaffing. It also increases costs to the patients, demands patient compliance and increases risks of antibiotics resistance. We did a study to see if the current practice can be justified. We compared current practice of prophylactic antibiotics to a proposed single dose regime of prophylactic antibiotics for women undergoing caesarean section. The current practice was standardized for the purpose of this study.
OBJECTIVES:
Main Objective
To compare the effectiveness of “single dose ceftriaxone and metronidazole” with the current practice of week-long course of prophylactic antibiotics for caesarean section.
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METHODOLOGY
A prospective Randomized Control Trial was done at Parirenyatwa and Harare hospitals from 2 February 2012 to 30 May 2012. Women undergoing caesarean sections were recruited following an inclusion and exclusion criteria. These were randomized into Arm 1 and Arm 2. Those in Arm 1 were given a single dose of Ceftriaxone and Metronidazole preoperatively and no more antibiotics postoperatively, except for treatment. Those in arm 2 were given a standardized week-long course of antibiotics representing the current practice. The patients were followed up for 6weeks.
The sample size of 260 patients was calculated, which meant 130 patients were needed for each arm. 280 patients were initially recruited but at the end, 232 were analysed after losing some patients during follow-up (see flow diagram).
RESULTS
Two hundred and thirty two patients were analyzed. 112 were in Arm 1 while 120 were in arm 2. These were compared for the incidence of hyperpyrexia, admission with puerperal sepsis, wound sepsis, prolonged hospital stay, laparotomy for pelvic abscess and mortality. Infective morbidity was defined by the presence of at least one of the above parameters. Infective morbidity occurred in 28 out of 232 (12%). 15 of these patients were in ARM 1 (Single dose group) while 13 were in ARM 2 (Week – long group). The difference was not statistically significant..
CONCLUSIONS
In this setting, the administration of single dose preoperative ceftriaxone 1g in combination with metronidazole 500mg, is clinically equivalent to the current practice of week-long course of antibiotics for the prevention of puerperal infections. We therefore recommend the single dose regimen due to lower costs and lesser burden to hospital staff who will administer reduced number of doses of antibiotics | |
