Comparison of single dose versus multiple doses of antibiotic prophylaxis in elective caesarean section




Cefuroxime, Caesarean delivery, Fever, Multi-dose, Prophylactic antibiotics, Single dose, Urine culture and sensitivity, Urine routine microscopy


Background: Infectious complications after caesarean delivery (CD) are a substantial cause of maternal morbidity, increase in hospital stay and treatment cost. The spectrum of these complications’ spreads from fever, wound infection, endometritis, urinary tract infection, and some serious complications like pelvic abscess, septic shock and septic pelvic vein thrombophlebitis. To prevent these prophylactic antibiotics have been used however the use of antibiotics should be judicious. Aim was to compare the efficacy of single dose versus multiple doses of antibiotics in elective caesarean section.

Methods: This study was conducted in a tertiary care hospital from December 2017 to May 2020. It was a prospective case control study. Sample size was 600, patients were randomly allocated in two groups A and B by card method. Pregnancy category B drug “cefuroxime” was given.

Results: Incidence of SSI was 2.7% (n=8) in single dose group and 3% (n=9) in multi-dose group, this difference was not statistically significant. Incidence of fever for more than 48 hours was 1.3% (n=4) in the single dose group and 0.6% (n=2) in multi-dose group, this difference was not statistically significant. Urine R/M for all patients on 3rd post-operative day, in single dose group 2.3% (n=7) patients and in multi-dose group 2.0 % (n=6) patients had more than 5 pus cells. Patients, who had more than 5 pus cells in urine R/M, were subjected to urine culture and sensitivity. Four (1.40%) patients in single dose group had positive cultures (E. coli was detected in three patients and Klebsiella pneumoniae in one) and three (1.0%) patients, in multi dose group, (all the three patients had E. coli in growth). These results were statistically not significant.

Conclusions: Single dose antibiotic prophylaxis was found to be comparable to multi-dose antibiotics in our study. Hence it is advocated that single dose antibiotic can be given in elective caesarean section as it is cost effective and as efficient as multi-dose regimen, ensures complete compliance and minimizes side effects and cut-down nursing work-load.

Author Biography

Vidhi Mishra, Department of Obstetrics and Gynecology, Max Hospital, Saket, New Delhi, India

Obstetrics and gynecology

senior resident


Wild SM. Antibiotic prophylaxis at caesarean section. Lancet. 2002;360(9334):724.

Rouzi AA, Khalifa F, Ba’ageel H. The routine use of cefazolin in cesarean section. Int J Obstet Gynecol. 2000;69;107-12.

Chelmow D Ruheli MS huang E. Prophylactic use of antibiotics for nonlaboring patients undergoing cesarean delivery with intact membrances; a metaanalysis. Am J Obstet Gynecol 2001;184;656-61.

Mah MW, Pyper AM, Oni GA, Impact of antibiotic prophylaxis on wound infection after cesarean section in a situation of expected higher risk. Am J Infect Control. 2001;29;85-8.

Dlamini LD, Sekikubo M, Tumukunde J, Kojjo C, Ocen D, Wabule A, et al. Antibiotic prophylaxis for caesarean section at a Ugandan hospital: a randomised clinical trial evaluating the effect of administration time on the incidence of postoperative infections. BMC Pregnancy Childbirth. 2015;15(1):1-7.

Centers for Disease Control and Prevention (CDC). National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Global Migration and Quarantine (DGMQ). Nonpharmaceutical Interventions (NPIs). CDC; 2020.

Borchardt RA, Tzizik D. Update on surgical site infections: the new CDC guidelines. J Am Acad Pas. 2018;31(4):52-4.

Nagarashi RD, Kshirsagar NS, Jadhav AJ, Patange RP. Comparative evaluation of single dose of prophylactic antibiotics against the post-operative antibiotic lower segment caesarean section. Int J Contemp Med Res. 2016;3(6):1609-161.

Prathima S, Savitha C, Tejeswini KK, Anitha GS. Comparative study of single dose versus multiple doses of antibiotic prophylaxis in caesarean delivery. Int J Reprod Contracept Obstet Gynecol. 2016;6(1):215-8.

Hebert PR, Reed G, Entman SS, Mitchel EF, Berg C, Griffin MR. Serious maternal morbidity after childbirth: prolonged hospital stays and readmissions. Obstet Gynecol. 1999;94:942-7.

Dhar H, Al-Busaidi I, Rathi B, Nimre EA, Sachdeva V, Hamdi I. A study of post-caesarean section wound infections in a regional referral hospital, Oman. Sultan Qaboos Univ Med J. 2014;14:e211-7.

Sandeep BK, Choudhary D. Efficacy of intravenous single dose of cefazolin versus multiple doses of cefazolin for antibiotic prophylaxis for cesarean section. J Dent Med Sci. 2016;92-7.

Ansari N, Das CR, Ansari MA. Evaluation of prophylactic antibiotic in caesarean section. J Nepalgunj Med Coll. 2016;12(2):40-1.

Shah Z, Kshirsagar NS, Shah S. Comparison of single dose prophylactic antibiotics versus five days antibiotic in cesarean section. J Evo Med Dent Sci. 2014;3:3123-9.

Lyimo FM, Massinde AN, Kidenya BR, Konje ET, Mshana SE. Single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean infection at Bugando Medical Centre in Mwanza, Tanzania: a randomized, equivalence, controlled trial. BMC Pregnancy Childbirth. 2013;13(1):123.

Westen EH, Kolk PR, Van Velzen CL, Unkels R, Mmuni NS, Hamisi AD, et al. Single‐dose compared with multiple day antibiotic prophylaxis for cesarean section in low‐resource settings, a randomized controlled, noninferiority trial. Acta Obstet Gynecol Scand. 2015;94(1):43-9.

Abro AH, Pathan AH, Siddiqui FG, Syed F, Laghari AA. Single dose versus 24-hours antibiotic prophylaxis against surgical site infections. J Liaquat Univ Med Health Sci. 2014;13:27-31.

Roex AJ, Puyenbroek JI, Van Loenen AC, Arts N. Single-versus three-dose cefoxitin prophylaxis in caesarean section: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol. 1987;25(4):293-8.

Borchardt RA, Tzizik D. Update on surgical site infections: The new CDC guidelines. J Am Acad Pas. 2018;31(4):52-4.

Nagarashi RD, Kshirsagar NS, Jadhav AJ, Patange RP. Comparative evaluation of single dose of prophylactic antibiotics against the post-operative antibiotic lower segment caesarean section. Int J Contemp Med Res. 2016;3(6):1609-161.

Borade SV, Syed O. Single dose antibiotic prophylaxis for prevention of surgical site infection in elective surgery. Int Surg J. 2017;5(1):27-33.

Bhattachan K, Baral GN, Gauchan L. Single versus multiple dose regimen of prophylactic antibiotic in cesarean section. Nepal J Obstet Gynaecol. 2013;8(2):50.

Siddig ET. Prophylactic antibiotics in elective caesarean section (ceftriaxone versus triple). University of Khartoum. 2002.

Mugisa GA, Kiondo P, Namagembe I. Single dose ceftriaxone and metronidazole versus multiple doses for antibiotic prophylaxis at elective caesarean section in Mulago hospital: A randomized clinical trial. AAS Open Res. 2018;1.

Sadique I, Abid S, Aleem S, Anwar S, Hafeez M, Pasha MI, et al. Single dose prophylaxis in obstetrics and gynaecological surgeries. Ann King Edward Med Univ. 2009;15(4):176.

Hafızoğlu RK, Kumbasar S, Şık BA, Bozkurt M, Ulaş M, Yumru AE, et al. Evaluation of the efficiency of antibiotic prophylaxis in cesarean cases. Proceed Obstet Gynecol. 2016;6(1):1-10.

Kamilya G, Seal SL, Mukherji J, Roy H, Bhattacharyya SK, Hazra A. A randomized controlled trial comparing two different antibiotic regimens for prophylaxis at cesarean section. J Obstet Gynecol India. 2012;62(1):35-8.

Shirimpaka E. Use of single dose pre-operative antibiotics in abdominal surgery a the University Teaching Hospital, Lusaka. The University of Zambia. 2007.

Vukomanovic P, Stefanovic M, Kutlesic R, Milosevic J, Golubovic Z, Stojiljkovic P. Antibiotic prophylaxis single center experience. Acta Facult Med Naiss. 2008;25(2):61-7.

Shakya A, Sharma J. Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity. Kathmandu Univ Med J. 2010;8(2):179-84.

Saxer F, Widmer A, Fehr J, Soka I, Kibatala P, Urassa H, et al. Benefit of a single preoperative dose of antibiotics in a sub-saharan district hospital: minimal input, massive impact. Ann Surg. 2009;249(2):322-6.

Gunn B, Ali S, Abdo-Rabbo A, Suleiman B. An investigation into perioperative antibiotic use during lower segment caesarean sections (LSCS) in four hospitals in Oman. Oman Med J. 2009;24(3):179.

Noyes N, Berkeley AS, Freedman K, Ledger W. Incidence of postpartum endomyometritis following single-dose antibiotic prophylaxis with either ampicillin/sulbactam, cefazolin, or cefotetan in high-risk cesarean section patients. Infect Dis Obstet Gynecol. 1998;6(5):220-3.

Gonik B, McGregor J. Comparison of short versus long half-life single-dose prophylactic antibiotics for cesarean section. Infect Dis Obstet Gynecol. 1994;2(3):120-5.

Pinto‐Lopes R, Sousa‐Pinto B, Azevedo LF. Single dose versus multiple dose of antibiotic prophylaxis in caesarean section: a systematic review and meta‐analysis. BJOG. 2017;124(4):595-605.

Ntirushwa D. A RCT comparing the effectiveness of a single dose of antimicrobial prophylaxis versus multiple doses during emergency caesarean section in Rwanda. University of Rwanda. 2016.






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