Single dose antibiotic prophylaxis in elective obstetric and gynaecological surgeries-a descriptive study




Elective surgeries, Single dose antibiotic, Prophylaxis, Wound infection


Background: Wound infection is a common complication of obstetric and gynaecological surgeries. It is not clear whether single dose perioperative prophylaxis with antibiotics is sufficient to prevent wound infections. This study was conducted to assess whether perioperative single dose antibiotic is effective in preventing post-operative infections in women undergoing elective obstetric and gynaecological surgeries.

Methods: Participants were administered a single dose of 1gm Cefotaxime intravenously before obstetric and gynecological surgery and followed up for the incidence of post-operative complications such as wound infections, wound resuturing etc.

Results: Study included 154 electives obstetric and gynecologic cases. 86 were obstetric cases and 68 were gynecologic surgeries. For gynecologic surgeries Cefotaxime injection 1g IV was given 30 minutes before surgery and for obstetric surgeries the same was given after cord clamping. Incidence of febrile morbidity was 5.8% in obstetric cases and 10.3% in gynecologic cases. Incidence of wound infection was 2.32% in obstetric cases and 1.47% in gynecologic cases. Three cases had wound infection, the organisms isolated in wound infection were E. coli, Pseudomonas, Methicillin resistant staphylococcus which were sensitive to cefoperazone-sulbactum and linezolid. The mean duration of hospital stay was 8.2 days in obstetric and 8.03 days for gynecologic patients.

Conclusions: Single dose Cefotaxime prophylaxis is equally effective compared to conventional multi-dose antibiotic therapy. It is cost effective and safe for both obstetric and gynecological surgeries.


Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999;27:97-134.

ACOG Committee on Practice Bulletins–Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol. 2009;113:1180-9.

National Institute for Health and clinical Excellence. Review of Clinical Guideline (CG74) - Prevention and treatment of surgical site infection. NICE;2011.

Cunningham FG. Cesarean delivery and peripartum hysterectomy. In: Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD, editors. William’s obstetrics. 22nd ed. New York: McGraw Hill; 2005:588-604.

Kamat AA, Brancazio L, Gibson M. Wound infection in gynecologic surgery. Infect Dis Obstet Gynecol. 2000;8:230-4.

McDonald M, Grabsch E, Marshall C, Forbes A. Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review. Aust N Z J Surg. 1998;68:388-96.

Lamont RF, Sobel JD, Kusanovic JP. Current debate on the use of antibiotic prophylaxis for caesarean section. BJOG. 2011;118:193-201.

Burke JF. The effective period of preventive antibiotic action in experimental incisions and dermal lesions. Surg. 1961;50:161-8.

Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal Health Study Group of the Canadian Perinatal Surveillance System. Maternal mortality and severe morbidity associated with low risk planned caesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176(4):455-60.

Harbarth S, Samore MH, Lichtenberg D, Carmeli Y. Prolonged antibiotic prophylaxis after cardiovascular surgery and its effect on surgical site infections and antimicrobial resistance. Circulation. 2000;101:2916-21.

Duff P, Park RC. Antibiotic prophylaxis in vaginal hysterectomy: a review. Obstet Gynecol. 1980;55:193S-202S.

Tanos V, Rojansky N. Prophylactic antibiotics in abdominal hysterectomy. J Am Coll Surg. 1994;179:593-600.

McGregor JA, French JI, Makowski E. Single-dose cefotetan versus multidose cefoxitin for prophylaxis in cesarean section in high-risk patients. Am J Obstet Gynecol. 1986;154:955-60.

Chang WC, Lee MC, Yeh LS et al. Quality-initiated prophylactic antibiotic use in laparoscopic-assisted vaginal hysterectomy. Aust N Z J Obstet Gynaecol. 2008;48:592-5.

Garner JS. CDC guideline for prevention of surgical wound infections, 1985. Supercedes guideline for prevention of surgical wound infections published in 1982. Infect Control. 1986;7(3):193-200.

Gourisankar K, Lall SS, Mukherji J, Roy H, Bhattacharyya SK, Hazra A. A Randomized Controlled Trial Comparing Two Different Antibiotic Regimen for Prophylaxis at Cesarean section. J Obstet Gynecol India. 2012;62(1):35-8.

Campillo F, Rubio JM. Comparative study of single dose cefotaxime and multiple doses of cefoxitin and cephazolin as prophylaxis in gynaecologic surgery. Am J Surg. 1992;164(4A Suppl):S12-5.

Tita ATN, Rouse DJ, Blackwell S, Saade GR, Spong Cy, Andrews WW. Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery: A Systematic Review. Obstetr Gynecol. 2009;113(3):675-82.

Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. Single dose antibiotic prophylaxis in elective obstetrics. William Obstetrics 22nd ed. USA: McGraw-Hill Education;2005.

John A, Jones, Howard W. Antibiotic prophylaxis in elective gynecology. Te Linde's Operative Gynecology 9th Ed: Lippincott Williams & Wilkins;2003:195-207.

Schaberg DR. Resistant gram-positive organisms. Ann Emerg Med. 1994;24(3):462-4.

Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991;91(3B):72S-5S.

Sadique I, Abid S, Aleem S, Anwar S, Hafeez M, Pasha M. et al. Single Dose Prophylaxis in Obstetrics and Gynecological Surgeries. Annals. 2009;15(4):176-9.

Sadaquat Jabeen, Rehena Rahim, Single Dose Versus Multi Dose Cephradine As Antibiotic Prophylaxis In Elective Abdominal Hysterectomy. JPMI. 2007;21(1):50-4.

Gonik B. Single versus three dose cefotaxime prophylaxis for caesarean section. Obstet Gynecol. 1985;65(2):189-93.

Shaheen S, Akhtar S. Comparison of single dose versus multiple doses of anitibiotic prophylaxis in elective caesarian. J Postgrad Med Inst. 2014;28(1):83-6.

Francis C, Mumford M, Strand ML, Moore ES, Strand EA. Timing of prophylactic antibiotic at cesarean section: a double-blinded, randomized trial J Perinatol. 2013;33(10):759-62.

Shakya A, Sharma J. Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective cesarean section infectious morbidity. KUMJ. 2010;8:30:179-84.

McDonald M, Grabsch E, Marshall C, Forbes A. single-versus multiple–dose antimicrobial prophylaxis for major surgery: a systematic review. Aust N Z J Surg. 1998;68(6):388-96.

Noyes N, Berkely AS, Freedman K, Ledger W. Incidence of post-partum endomyometritis following single-Dose antibiotic prophylaxis with either Ampicillin/Sulbactum, Cefazoline, or Cefotan in high risk cesarean section patients. Infect Dis. Obstet Gynecol. 1998;6:220-3.






Original Research Articles