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Comparison between Azithromycin and Cephalexin for Preventing Infection after Cesarean Section in Obese Patient

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DOI: 10.4236/ijcm.2014.519155    3,369 Downloads   4,285 Views  

ABSTRACT

Introduction: Postcesarean infection can cause maternal mortality and morbidity. Use of prophylactic antibiotics could decrease surgical site infection. Despite using prophylactic antibiotics in obese women, compared to normal weighted women the rate of wound infection is higher in this group. The aim of this study is to compare prophylactic effect of azithromycin and cephalexin on febrile morbidity and postcesarean infection in women with BMI > 30. Methods and Materials: This randomized controlled double blind clinical trial was done on 231 women with BMI > 30 who underwent elective cesarean section. Patients were randomly divided to intervention and control groups. Keflin 2 gr IV was administered 0.5 hr before surgery for both intervention and control groups. Cefalexin (placebo) every 6 hr and azythromycin (placebo) every 12 hr for control group and cephalexin 500 mg every 6 hr and azithromycin 250 mg every 12 hr for intervention group were administered for 48 hrs. Patients were under observation till 1 month after surgery. Fever, wound infection, endometritis and hospitalization were compared between two groups with SPSS v. 18. Results: A total of 231 patients 113 (48.9%) were enrolled in intervention group and 118 (51.1%) in control group with mean age of (28.53 ± 5.51) recruited. BMI distribution did not differ in the two groups. Hospitalization in control group was significantly higher than that in intervention group (2.58 ± 0.99) vs (2.11 ± 0.45) (P value < 0.001). BMI in intervention group with and without fever was (34.62 ± 2.64) and (30.89 ± 2.80), respectively (P value < 0.001). In control group, BMI in patients with and without fever was (38.60 ± 2.80) and (31.29 ± 1.28), respectively (P value = 0.001). Fever and endometritis simultaneously was seen in 3 (2.7%) of intervention group and 8 (6.8%) of control group. In interventions 3 (2.7%) had fever but no endometritis and 2 (1.8%) had endometritis but no fever (P < 0.001). In control group, 23 (19.5%) patients had fever but no endometritis and 4 (3.4%) patients had endometritis but no fever (P value < 0.001). Febrile patients in control group 31 (26.3%) were significantly more than those in intervention group 6 (5.3%) (P value < 0.001). Discussion: Administration of prophylactic azithromycin and cephalexin resulted in a decrease in febrile morbidity and length of hospital stay and is recommended. BMI of patients with fever was significantly higher in both intervention and control groups compared to those who didn’t experience fever. Postcesarean endometritis wasn’t significantly different in two groups. Postcesarean wound infection wasn’t seen in any group.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Azizi, M. , Rajaei, M. , Abbasian, M. , Ghanbarnejad, A. , Najafian, A. and Iranfar, M. (2014) Comparison between Azithromycin and Cephalexin for Preventing Infection after Cesarean Section in Obese Patient. International Journal of Clinical Medicine, 5, 1214-1220. doi: 10.4236/ijcm.2014.519155.

References

[1] (2004) Antibiotic Prophylaxis for Surgery. Treatment Guidelines. The Medical Letter, 2, 27-32.
[2] Kirkland, K.B., Briggs, J.P., Trivette, S.L., Wilkinson, W.E. and Sexton, D.J. (1999) The Impact of Surgical Site Infections in the 1990s: Attributable Mortality, Excess Length of Hospitalization, and Extra Costs. Infection Control & Hospital Epidemiology, 20, 725-730.
http://dx.doi.org/10.1086/501572
[3] (1999) ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. AJHP, 56, 1839-1887.
[4] Classen, D.C., Evans, R.S., Pestotnik, S.L., Horn, S.D., Menlove, R.L. and Burke, J.P. (1992) The Timing of Prophylactic Administration of Antibiotics and the Risk of Surgical-Wound Infection. New England Journal of Medicine, 326, 281-286.
http://dx.doi.org/10.1056/NEJM199201303260501
[5] Mangram, A.J., Horan, T.C., Pearson, M.L., Silver, L.C. and Jarvis, W.R. (1999) Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. American Journal of Infection Control, 27, 97-132.
http://dx.doi.org/10.1016/S0196-6553(99)70088-X
[6] American Society of Health System Pharmacists (1999) ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. American Society of Health-System Pharmacists. American Journal of Health-System Pharmacy, 56, 1839-1888.
[7] Smaill, F. and Hofmeyr, G.J. (2002) Antibiotic Prophylaxis for Cesarean Section. Cochrane Database of Systematic Reviews, 2002, Article ID: CD000933.
[8] Centers for Medicare & Medicaid Services (2008) Physician Quality Reporting Initiative (PQRI) Quality Measures Specifications.
http://www.cms.hhs.gov/PQRI/downloads/2008PQRIMeasureSpecifications123107.pdf
[9] American College of Obstetricians and Gynecologists (2003) ACOG Practice Bulletin Number 47, October 2003: Prophylactic Antibiotics in Labor and Delivery. Obstetrics & Gynecology, 102, 875-882.
http://dx.doi.org/10.1016/S0029-7844(03)00984-0
[10] Martin, J.A., Hamilton, B.E., Sutton, P.D., et al. (2007) Births: Final Data for 2005. National Vital Statistics Reports, 56, 1-103.
[11] Hamilton, B.E., Martin, J.A. and Ventura, S.J. (2007) Births: Preliminary Data for 2006. National Vital Statistics Reports, 56, 1-18.
[12] MacDorman, M.F., Menacker, F. and Declercq, E. (2008) Cesarean Birth in the United States: Epidemiology, Trends, and Outcomes. Clinics in Perinatology, 35, 293-307.
http://dx.doi.org/10.1016/j.clp.2008.03.007
[13] Bratzler, D.W. and Houck, P.M. (2005) Antimicrobial Prophylaxis for Surgery: An Advisory Statement from the National Surgical Infection Prevention Project. The American Journal of Surgery, 189, 395-404.
http://dx.doi.org/10.1016/j.amjsurg.2005.01.015
[14] Surgical Infection Prevention Data (SIP) Florida Agency for Healthcare Administration (AHCA).
http://ahca.myflorida.com
[15] United States Department of Health & Human Services. HHS Hospital Compare: Information for Professionals.
http://www.hospitalcompare.hhs.gov/
[16] Edwards, F.H., Engelman, R.M., Houck, P., Shahian, D.M. and Bridges, C.R. (2006) The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part I: Duration. The Annals of Thoracic Surgery, 81, 397-404.
http://dx.doi.org/10.1016/j.athoracsur.2005.06.034
[17] Fabian, T.C., Croce, M.A., Payne, L.W., Minard, G., Pritchard, F.E. and Kudsk, K.A. (1992) Duration of Antibiotic Therapy for Penetrating Abdominal Trauma: A Prospective Trial. Surgery, 112, 788-795.
[18] Pevzner, L., Swank, M., Krepel, C., Wing, D.A., Chan, K. and Edmiston Jr., C.E. (2011) Effects of Maternal Obesity on Tissue Concentrations of Prophylactic Cefazolin during Cesarean Delivery. Obstetrics & Gynecology, 117, 877-880.
[19] Bozorgzadeh, A., Pizzi, W.F., Barie, P.S., Khaneja, S.C., LaMaute, H.R., Mandava, N., et al. (1999) The Duration of Antibiotic Administration in Penetrating Abdominal Trauma. The American Journal of Surgery, 177, 125-131.
http://dx.doi.org/10.1016/S0002-9610(98)00317-1
[20] Luchette, F.A., Borzotta, A.P., Croce, M.A., O’Neill, P.A., Whittmann, D.H., Whittmann, D.H., et al. (2006) Practice Management Guidelines for Prophylactic Antibiotic Use in Penetrating Abdominal Trauma.
http://www.east.org
[21] Chang, W.T., Lee, K.T., Chuang, S.C., Wang, S.N., Kuo, K.K., Chen, J.S., et al. (2006) The Impact of Prophylactic Antibiotics on Postoperative Infection Complication in Elective Laparoscopic Cholecystectomy: A Prospective Randomized Study. The American Journal of Surgery, 191, 721-725.
http://dx.doi.org/10.1016/j.amjsurg.2006.01.050
[22] Song, F. and Glenny, A.M. (1998) Antimicrobial Prophylaxis in Colorectal Surgery: A Systematic Review of Randomized Controlled Trials. British Journal of Surgery, 85, 1232-1241.
http://dx.doi.org/10.1046/j.1365-2168.1998.00883.x
[23] Barie, P.S. (2002) Surgical Site Infections: Epidemiology and Prevention. Surgical Infections, 3, S9-S21.
http://dx.doi.org/10.1089/sur.2002.3.s1-9
[24] Lewis, R.T., Goodall, R.G., Marien, B., Park, M., Lloyd-Smith, W. and Wiegand, F.M. (1991) Efficacy and Distribution of Single-Dose Preoperative Antibiotic Prophylaxis in High-Risk Gastroduodenal Surgery. Canadian Journal of Surgery, 34, 177-222.
[25] ACOG Committee on Practice Bulletins (2006) ACOG Practice Bulletin No. 74: Antibiotic Prophylaxis for Gynecologic Procedures. Obstetrics & Gynecolog, 108, 225-234.
http://dx.doi.org/10.1097/00006250-200607000-00057
[26] Stork, C.M. (2006) Antibiotics, Antifungals, and Antivirals. In Nelson, L.H., Flomenbaum, N., Goldfrank, L.R., Hoffman, R.L., Howland, M.D. and Lewin, N.A., Eds., Goldfrank’s Toxicologic Emergencies, McGraw-Hill, New York, 847.
[27] (1994) Antimicrobial Prophylaxis in Surgery (Clinical Practice Guidelines). Canadian Medical Association Journal, 151, 925-931.
[28] Harger, J.H. and English, D.H. (1981) Selection of Patients for Antibiotic Prophylaxis in Cesarean Sections. American Journal of Obstetrics & Gynecology, 141, 752-758.
[29] O’Leary, J.A., Mullins Jr., J.H. and Andrinopoulos, G.C. (1986) Ampicillin vs. Ampicillin-Gentamicin Prophylaxis in High-Risk Primary Cesarean Section. Journal of Reproductive Medicine, 31, 27-30.
[30] Andrews, W.W., Hauth, J.C., Cliver, S.P., Savage, K. and Goldenberg, R.L. (2003) Randomized Clinical Trial of Extended Spectrum Antibiotic Prophylaxis with Coverage for Ureaplasma urealyticum to Reduce Post-Cesarean Delivery Endometritis. Obstetrics & Gynecology, 101, 1183-1189.
http://dx.doi.org/10.1016/S0029-7844(03)00016-4
[31] Tita, A.T., Hauth, J.C., Grimes, A., Owen, J., Stamm, A.M. and Andrews, W.W. (2008) Decreasing Incidence of Post-Cesarean Endometritis with Extended-Spectrum Antibiotic Prophylaxis. Obstetrics & Gynecology, 111, 51-56.
http://dx.doi.org/10.1097/01.AOG.0000295868.43851.39
[32] Tita, A., Rouse, D.J., Blackwell, S., Saade, G.R., Spong, C.Y. and Andrews, W.W. (2009) Evolving Concepts in Antibiotic Prophylaxis for Cesarean Delivery: A Systematic Review. Obstetrics & Gynecology, 113, 675-682.
http://dx.doi.org/10.1097/AOG.0b013e318197c3b6

  
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