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Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section
Open accessAbstract
BACKGROUND: The single most important risk factor for postpartum maternal infection is cesarean section. Although guidelines endorse the use of prophylactic antibiotics for women undergoing cesarean section, there is not uniform implementation of this recommendation. This is an update of a Cochrane review first published in 1995 and last updated in 2010. OBJECTIVES: To assess the effects of prophylactic antibiotics compared with no prophylactic antibiotics on infectious complications in women undergoing cesarean section. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014) and reference lists of retrieved papers. SELECTION CRITERIA: Randomized controlled trials (RCTs) and quasi-RCTs comparing the effects of prophylactic antibiotics versus no treatment in women undergoing cesarean section. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. The clinically important primary outcomes were wound infection, endometritis, serious maternal infectious complications and adverse effects on the infant. We presented dichotomous data as risk ratios (RR), with 95% confidence intervals (CIs) and combined trials in meta-analyses. We assessed the quality of evidence using the GRADE approach. MAIN RESULTS: We identified 95 studies enrolling over 15,000 women. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection (RR 0.40, 95% CI 0.35 to 0.46, 82 studies, 14,407 women), endometritis (RR 0.38, 95% CI 0.34 to 0.42, 83 studies, 13,548 women) and maternal serious infectious complications (RR 0.31, 95% CI 0.20 to 0.49, 32 studies, 6159 women). When only studies that included women undergoing an elective cesarean section were analyzed, there was also a reduction in the incidence of wound infections (RR 0.62, 95% CI 0.47 to 0.82, 17 studies, 3537 women) and endometritis (RR 0.38, 95% CI 0.24 to 0.61, 15 studies, 2502 women) with prophylactic antibiotics. Similar estimates of effect were seen whether the antibiotics were administered before the cord was clamped or after. The effect of different antibiotic regimens was studied and similar reductions in the incidence of infections were seen for most of the antibiotics and combinations.There were no data on which to estimate the effect of maternal administration of antibiotics on infant outcomes. No studies systematically collected and reported on adverse infant outcomes nor the effect of antibiotics on the developing infant immune system. No studies reported on the incidence of oral candidiasis (thrush) in babies. Maternal adverse effects were also rarely described.We judged the evidence for antibiotic treatment compared with no treatment to be of moderate quality; most studies lacked an adequate description of methods and were assessed as being at unclear risk of bias. AUTHORS' CONCLUSIONS: The conclusions of this review support the recommendation that prophylactic antibiotics should be routinely administered to all women undergoing cesarean section to prevent infection. Compared with placebo or no treatment, the use of prophylactic antibiotics in women undergoing cesarean section reduced the incidence of wound infection, endometritis and serious infectious complications by 60% to 70%. There were few data on adverse effects and no information on the effect of antibiotics on the baby, making the assessment of overall benefits and harms difficult. Prophylactic antibiotics given to all women undergoing elective or non-elective cesarean section is beneficial for women but there is uncertainty about the consequences for the baby.
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“Peri-cesarean antibiotic prophylaxis (a single dose of β-lactam antibiotic) prior to cesarean delivery reduces the incidence of postpartum endometritis threefold.[26, 27]”
From Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital (2017) · cites this paper as [26]
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Kravtsova, O. N., Валерьевна, Д. Е., Ignatieva, M. A., & Борисовна, Е. Е. (2026) · Russian Bulletin of Obstetrician-Gynecologist · doi:10.17116/rosakush20262605171
Preventive antibiotics in surgery
Cohen, S. H., & Brown, J. L. (2013) · Cambridge University Press eBooks · doi:10.1017/cbo9780511920660.027
Fernandes, J. Z., Pizzinatto, N. L., Santos, G. L. C., Name, B. D. H., & Ruszczyk, G. B. (2026) · International Health Sciences Review · doi:10.70164/ihsr.v2i2.167
Metadata
- Authors
- Smaill, F. M., & Grivell, R. M.
- Affiliations
- McMaster University (CA)
- Women's and Children's Hospital (AU)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2014-10-28
- Volume
- 2014
- Issue
- 10
- Pages
- CD007482-CD007482
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC8078551
- OpenAlex
- W1771339314
- Cited by
- 575
- References
- 206
- Citations by year
- 2026: 13 · 2025: 28 · 2024: 34 · 2023: 34 · 2022: 58 · 2021: 52 · 2020: 54 · 2019: 48 · 2018: 42 · 2017: 49 · 2016: 30 · 2015: 22 · 2014: 29
- FWCI
- 8.18
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and Maternal Infections
- Keywords
- antibiotic prophylaxis, cesarean section, surgical site infection, endometritis, elective cesarean section, antibiotic adverse effects, neonatal infection
- MeSH terms
- Bacterial Infections, Cesarean Section, Endometritis, Female, Humans, Postoperative Complications, Pregnancy, Surgical Wound Infection, Urinary Tract Infections, Randomized Controlled Trials as Topic, Antibiotic Prophylaxis
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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