An Audit Into The Use of Prophylactic Antibiotics During Caesarean Section at a Central Teaching Hospital - Are National Guidelines Being Followed?
Author: Dr A T Sawati
Maternity Unit, Southern GeneralHospital, Glasgow, UK
OBJECTIVES: To determine if the use of antibiotics during caesarean section is in accordance with the latest national guidelines which state that (1) Antibiotics should be administered before skin incision and (2) Co-amoxiclav should not be used (NICE Guidelines 2011).
BACKGROUND:Traditionally prophylactic antibiotics were administered after cord clamp due to concerns regarding fetal exposure to antibiotics. Guidelines now state that prophylactic antibiotics should be given before skin incision with studies suggesting a reduction in post-caesarean maternal infection by up to 50%.Co-amoxiclav is not recommended due to its association with necrotising enterocolitis in the neonate.
METHODS:This was a prospective audit with data collected over a period of 4 weeks from May to June 2012. The time of skin incision, time of antibiotic administration, type of caesarean section (elective or emergency) and name of antibiotic used were recorded onto structured proformas. Information was obtained from the patient’s pregnancy and anaesthetic notes.
RESULTS: All 65 patients were given prophylactic antibiotics after skin incision. In 59 out of 65 patients Co-amoxiclav only was used. Clindamycin was used in 2 cases and Cefuroxime in 3 cases. In one case an extended spectrum regimen was used with Co-amoxiclav and Metronidazole. The type of caesarean section did not affect the timing of antibiotic administration or the type of antibiotic used.
CONCLUSION: Prophylactic antibiotics are not being administered in accordance with the latest national guidelines. Review of the current antibiotic policy is required with close liaison between the Obstetric and Anaesthetic teams.
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Dr Awess Sawati
Address: 27 Dumbreck Road, Glasgow, G41 5LJ
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