Caesarean section
For patients receiving intrapartum prophylaxis against Streptococcus agalactiae (group B streptococcus) or treatment for intra-amniotic infection (chorioamnionitis), additional surgical antibiotic prophylaxis is required, unless the antibiotic regimen has activity against the organism(s) most likely to cause postoperative infections (eg cefazolin, clindamycin plus gentamicin). Furthermore, adequate plasma and tissue concentrations must be achieved at the time of surgical incision and for the duration of the procedure. See Surgical antibiotic prophylaxis for patients receiving treatment for established infection.
Although it has previously been recommended that prophylaxis be given after cord clamping to avoid theoretical risks to the neonate (eg maternal anaphylaxis), studies have confirmed that administration before surgical incision results in lower infection rates without compromising the neonate.
For prophylaxis for caesarean section, use:
cefazolin 2 g intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed1. surgical prophylaxis, Caesarean section cefazolin
For patients colonised or infected with methicillin-resistant Staphylococcus aureus (MRSA), or at increased risk of being colonised or infected with MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), add vancomycin to the above regimen:
vancomycin 15 mg/kg up to 2 g intravenously, started within the 120 minutes before surgical incision (recommended rate 10 mg/minute)2; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, Caesarean section vancomycin
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use cefazolin, with or without vancomycin, as above. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins who are neither colonised or infected with MRSA, nor at increased risk of being colonised or infected with MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), use:
clindamycin 600 mg intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed surgical prophylaxis, Caesarean section clindamycin
PLUS
gentamicin 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before surgical incision34; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, Caesarean section gentamicin
For patients with immediate severe or delayed severe hypersensitivity to penicillins who are colonised or infected with MRSA, or at increased risk of being colonised or infected with MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), use:
vancomycin 15 mg/kg up to 2 g intravenously, started within the 120 minutes before surgical incision (recommended rate 10 mg/minute) 2; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed vancomycin
PLUS
gentamicin 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before surgical incision 34; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed. gentamicin
A randomised controlled trial demonstrated a reduction in postoperative infection when azithromycin was added to cefazolin for prophylaxis for nonelective caesarean section deliveries5 . However, this study has limitations, and there are concerns about possible adverse effects of this regimen, particularly effects on the neonate. It is not currently recommended for routine practice.