Among obese women undergoing cesarean delivery, a postoperative 48-hour course of antibiotics significantly decreased the rate of surgical site infection within 30 days after delivery, according to a study published by JAMA.
The rate of obesity among U.S. women has been increasing, and obesity is associated with an increased risk of surgical site infection (SSI) following cesarean delivery. The optimal antibiotic regimen around the time of cesarean delivery to prevent as SSI in this high-risk population is unknown. Carri R. Warshak, M.D., of the University of Cincinnati, and colleagues randomly assigned obese women (prepregnancy BMI 30 or greater) who had received standard intravenous preoperative cephalosporin (an antibiotic) to receive oral cephalexin, 500 mg, and metronidazole, 500 mg (n = 202), vs identical-appearing placebo (n = 201) every 8 hours for a total of 48 hours following cesarean delivery.
The researchers found that the overall rate of SSI (defined as any superficial incisional, deep incisional, or organ/space infections within 30 days after cesarean delivery) was 10.9 percent. Surgical site infection was diagnosed in 6.4 percent of the women in the cephalexin-metronidazole group vs 15.4 percent in the placebo group. There were no serious adverse events, including allergic reaction, reported in either group.
The study notes some limitations, including that the trial was performed at a single site with a high prevalence of obesity, which may not be generalizable to all obstetric practices.
"For prevention of SSI among obese women after cesarean delivery, prophylactic oral cephalexin and metronidazole may be warranted," the authors write.
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Carri R. Warshak, MD et al. (2017). Effect of Post–Cesarean Delivery Oral Cephalexin and Metronidazole on Surgical Site Infection Among Obese Women: A Randomized Clinical Trial. JAMA. DOI: 10.1001/jama.2017.10567