The mostly common complication of ...

The mostly common complication of cesarean delivery, endometritis, is believed to be the effect from ascending infection caused from a mixture of organisms. Ureaplasma urealyticum is recognized increasingly as an important pathogen in local postpartum infections. Because the antibiotics routinely used for prophylaxis in cesarean delivery are not effective against this organism, Andrews and colleagues studied the general intent of prophylaxis with extended-spectrum antibiotics with efficacy against U urealyticum.

About 600 mothers who gave birth by way of nonurgent cesarean delivery in a university hospital between 1996 and 1999 were included in the studious mood Exclusions included mothers with febrile disease an immunocompromised condition, allergy to consideration medications, or use of medications metabolized through cytochrome P450 systems. All mothers received intravenous cefotetan at the clamping of the umbilical cord. Mothers then were randomly assigned to treatment with doxycycline plus azithromycin or identical placebos. The reflection was double-blinded. Patients were monitored for agitation (38[degrees]C [100.4[degrees]F]) or higher) and other indications of endometritis as it was as tachycardia, infected lochia, uterine tendernes and leukocytosis.

The 301 women who received antibiotics were comparable with the 296 women who received placebo in all important variables, including those related to surgery Overall, 122 (204 percent) mothers unraveled endometritis. The rate of endometritis was significantly lower in mothers treated with doxycycline plus azithromycin (169 percent) than it was in mothers in the placebo dispose (24.7 percent). Mothers treated with additional antibiotics were also four times les likely to disclose wound infections and had a significant mean reduction of 18 hours in hospital stay (see accompanying table).

The authors end that extending prophylactic antibiotic coverage to include U urealyticum was associated with significant reductions in clinical endometritis and pain infections following cesarean delivery. They make acceptable that this approach be more widely considered, especially in mothers at increased risk of postdelivery infectious morbidity.

Andrews WW et al. Randomized clinical trial of expanded spectrum antibiotic prophylaxis with coverage for Ureaplasma urealyticum to remodel post-cesarean delivery endometritis. Obstet Gynecol June 2003;101:1183-9

COPYRIGHT 2004 American Academy of Family Physicians

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