Antibiotic prophylaxis for cesarean delivery: is an extended-spectrum agent necessary?

The purpose of this investigation was to determine whether an extended-spectrum antibiotic with a long duration of action was more effective for prophylaxis for cesarean delivery than a limited-spectrum agent with a shorter duration of action. Patients were eligible for the study if they were in labor or had ruptured membranes at the time of surgery. In a randomized, double-blind manner, 377 women were assigned to receive 2 g of cefazolin (192) or 2 g of cefotetan (185) intravenously immediately after the infant's umbilical cord was clamped. There were no significant differences between groups with respect to the frequency of febrile morbidity (22.4 versus 21.6%), the mean fever index (15.8 versus 14.9 degree-hours), the frequency of endometritis (19.3 versus 21.1%), or the mean duration of postoperative hospitalization (3.8 versus 3.9 days). Among patients who became infected despite prophylaxis, enterococcus was isolated with disproportionate frequency. This organism was responsible for 89% of the postoperative urinary tract infections and all three cases of bacteremia. It was also the second most common isolate in women with endometritis. A single dose of cefazolin is comparable in effectiveness to cefotetan. In view of the cost difference between the two antibiotics, there is no justification for use of the more expensive, extended-spectrum agent.