Benefits, Harms, and Costs
- 1.Available evidence does not support the use of prophylactic antibiotics to reduce infectious morbidity following operative vaginal delivery (II-1).
- 2.There is insufficient evidence to argue for or against the use of prophylactic antibiotics to reduce infectious morbidity for manual removal of the placenta (III).
- 3.There is insufficient evidence to argue for or against the use of prophylactic antibiotics at the time of postpartum dilatation and curettage for retained products of conception (III).
- 4.Available evidence does not support the use of prophylactic antibiotics to reduce infectious morbidity following elective or emergency cerclage (II-3).
- 1.All women undergoing elective or emergency Caesarean section should receive antibiotic prophylaxis (I-A).
- 2.The choice of antibiotic for Caesarean section should be a single dose of a first-generation cephalosporin. If the patient has a penicillin allergy, clindamycin or erythromycin can be used (I-A).
- 3.The timing of prophylactic antibiotics for Caesarean section should be 15 to 60 minutes prior to skin incision. No additional doses are recommended (I-A).
- 4.If an open abdominal procedure is lengthy (>3 hours) or estimated blood loss is greater than 1500 mL, an additional dose of the prophylactic antibiotic may be given 3 to 4 hours after the initial dose (III-L).
- 5.Prophylactic antibiotics may be considered for the reduction of infectious morbidity associated with repair of third and fourth degree perineal injury (I-B).
- 6.In patients with morbid obesity (BMI >35), doubling the antibiotic dose may be considered (III-B).
- 7.Antibiotics should not be administered solely to prevent endocarditis for patients who undergo an obstetrical procedure of any kind (III-E).
Abbreviations:CDC (Centers for Disease Control and Prevention), IE (infective endocarditis), SSI (surgical site infection)
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This Clinical Practice Guideline has been prepared by the Infectious Diseases Committee