Saturday, 26 November 2022
Monday, 14 November 2022
ANTIBIOTIC PROPHYLAXIS IN CESAREAN SECTION
Prophylactic use of antibiotics effectively reduces postoperative infectious morbidity both for the mother and the neonate. Postoperative morbidity like fever, endometritis, wound infection, peritonitis, and also pelvic abscess can significantly be reduced. However an institution, where infection rate is high, should primarily improve the surgical and aseptic technique. Emergency cesarean section is associated with higher rate of infection than the elective procedure. Similarly cases with prolonged rupture of membranes and in prolonged labor are at higher risk of infection. Infective agents are mostly polymicrobial, including Gram-positive, Gram-negative aerobes and anaerobes. Generally antibiotics with broad spectrum activity are better.
Use of Ceftriaxone (1 g), Cefuroxime (1.5 g) or Co-Amoxiclav (1.2 g) by intravenous route which is a reasonable choice. Shorter courses of 1-3 doses are to be given. This can reduce the cost compared to a full 7 days course.
First dose to the mother is given before the skin incision is made. Ideally the antibiotic infusion should be timed so that a bactericidal serum level is reached by the time skin incision is made.
It is recommended that prophylactic antibiotic should be administered within 60 minutes of the start of the cesarean delivery. When this is not possible it should be started as soon as possible (ACOG). This avoids antibiotic exposure to the baby. Bacteriology pattern and antibiotic sensitivity need to be monitored regularly by the microbiology laboratory. Antibiotic prophylaxis has no deleterious effects on the mother or the neonate.
Wednesday, 9 November 2022
Tuesday, 8 November 2022
Monday, 7 November 2022
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