Antibiotic Prophylaxis in Obstetric Procedures

Goals of Prophylatic Antibiotics:

• Prevent infection
• Have therapeutic tissue levels at the time microbial contamination might occur

Cesarean Delivery

• All women undergoing elective or emergent Cesarean delivery should receive prophylactic antibiotics. (I-A)
• The choice of antibiotics for elective Cesarean prophylaxis should be a single dose of a first-generation cephalosporin. If the cesarean is non-elective or rupture of membranes has occurred a first-generation cephalosporin and Azithromycin should be given..  If the patient has an anaphylactic Penicillin allergy, Clindamycin and Gentamicin should be used. (I-A)
• The timing of antibiotic prophylaxis should be 15 to 60 minutes prior to skin incision. (I-A)

Cesarean prophylaxis:  Cefazolin 2 grams IV,  OR if obese (>100kg)  Cefazolin 3 grams IV
Add Azithromycin 500 mg IV, if non-elective cesarean.
​
If patients have chorioamnionitis and are therefore being treated with Ampicillin and Gentamycin, Clindamycin should be given preoperatively and Azithromycin should NOT be given. In patients with PPROM who have been receiving Azithromycin, no additional Azithromycin dosing is needed.

In patients with Penicillin anaphylaxis, Clindamycin 900 mg IV and Gentamicin 5 mg/kg (base on ideal body weight, if obese.  Not to exceed 400 mg total.)

In addition for all cesarean patients, a vaginal prep should be done using Betadine. If the patient is allergic to Betadine, Hibiclens may be substituted.

The following procedures have no strong data to recommend the use of prophylactic antibiotics or not; therefore, each case will have to be assessed on an individual basis until future evidence based studies are performed.

• Manual removal of the placenta
• Postpartum dilatation and curettage for retained products of conception
• Repair of third and fourth degree perineal injury

Prophylatic antibiotics are clearly indicated in the setting of PPROM.  See PPROM guideline for specific recommendations.

References

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin  No. 120: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol 2011;117:1472-1483.

Van Schalkwkyk J, Van Eyk N. Antibiotic prophylaxis in obstetric procedures. J Obstet Gynaecol Can 2010;32(9):878-884.
​
Tita ATN, Szychowski JM, Boggess K et al. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. N Engl J Med 2016;
​375:1231-1241.