- 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.
- 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.
- Literature review and expert commentary.
- Funding: None disclosed.
- Recommendations are based on current evidence and may change with future studies.