ACOG Practice Bulletin: using prophylactic antibiotics with CD

  • Obstet Gynecol
  • 01/09/2018

  • Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Prophylactic antibiotics should be used with cesarean delivery (CD), says the American College of Obstetricians and Gynecologists (ACOG) in a Practice Bulletin on prophylaxis in labor and delivery.

Key recommendations

  • All patients undergoing cesarean delivery (CD) should receive prophylactic antibiotics within 60 minutes of the start of surgery unless they are already receiving broad-spectrum antibiotics. 
  • When this is not possible, antibiotics should be given as soon as possible after the incision is made.
  • Examples of appropriate antibiotics include: cefazolin, cefotetan, cefuroxime, ampicillin, piperacillin, cefoxitin, and ampicillin-sulbactam.
  • Azithromycin may be an alternative and can be used in addition to a first-generation cephalosporin. 
  • If allergic, clindamycin plus aminoglycoside can be used.
  • Vaginal cleansing with povidone-iodine or chlorhexidine gluconate can be considered prior to CD.
  • Skin should be cleaned with alcohol-based solution prior to CD.
  • Infective endocarditis prophylaxis is not routinely recommended.
  • For patients with preterm premature rupture of membranes at
  • Antibiotics may be indicated for third- and fourth-degree lacerations.
  • Larger doses may be required for obese patients.

Study design

  • Literature review and expert commentary.
  • Funding: None disclosed.

Limitations

  • Recommendations are based on current evidence and may change with future studies.