ANTIBIOTICS FOR ELECTIVE CEASAREAN SECTION – A COMPARISON OF PROPHYLACTIC SINGLE DOSE CEFTRIAXONE AND A COMBINATION OF AMPICLOX, GENTAMICIN AND METRONIDAZOLE IN THERAPEUTIC DOSES

Abstract

This study aims at comparing the clinical efficacy of Ceftriaxone and
Ampiclox, Gentamicin and Metronidazole in decreasing the frequency of post
caesarean section infection related morbidity.
Two hundred Patients planned for caesarean section for various
indications (e.g. breech presentation, two previous caesarean sections
placenta praevia e.t.c) and who satisfied the inclusion criteria were randomly
given either ceftriaxone (single dose) or a combination of ampliclox,
gentamicin and metronidazole after clamping of the cord and for seven days
thereafter.
All participants were examined to screen for infection and had a
midstream or catheter specimen of urine collected for microscopy,
culture and sensitivity before surgery and on postoperative days 3 and
5, an endocervical and wound swabs for microscopy culture and
sensitivity were also collected on postoperative days 3 and 5. Those
who developed febrile morbidity were examined to localize the potential
source of infection (wound, tonsils, breasts, chest, abdomen and
pelvis), total white blood cells count and differentials, as well as blood
was sent for culture and sensitivity testing. Blood films (thick and thin)
were also taken and stained for malaria parasite.
Participants who developed endometritis, wound infection, urinary
tract infection were treated based on the organism grown on culture and
its antibiotic sensitivity pattern.The mean age, parity, gestational age and packed cell volume
were similar in the two groups. There was no significant statistical
difference in the incidence of febrile morbidity ( p = 0.774 ), endometritis
( p = 0.841 ), wound infection ( p = 0.788 ), urinary tract infection ( p =
0.400 ) and mean duration of hospital stay ( p = 0.412 ). The mean cost
of antibiotic treatment in the ceftriaxone group was 1202.50Naira and
1980.53Naira for the combination of Ampiclox, Gentamicin and
Metronidazole and this was statistically significant ( p = 0.000).
A single dose of Ceftriaxone was as effective as a combination of
Ampiclox, Gentamicin and Metronidazole in preventing post caesarean
section infectious complications and is cheaper and easier to
administer.

ANTIBIOTICS FOR ELECTIVE CEASAREAN SECTION – A COMPARISON OF PROPHYLACTIC SINGLE DOSE CEFTRIAXONE AND A COMBINATION OF AMPICLOX, GENTAMICIN AND METRONIDAZOLE IN THERAPEUTIC DOSES