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Re: Prophylactic antibiotics at csectionFrom: DoctorJoe@aol.comFri Mar 26 05:36:47 2004
In a message dated 3/25/04 8:39:46 PM, Glen.Elrod@ELMENDORF.af.mil writes: << The newest ACOG technical bulletin on prophylactic antibiotics in Ob/Gyn states that prophylactic antibiotics are acceptable for csections. According to this it is "most commonly given after cord clamp." Having just sat on a meeting of our infectious disease board reviewing postoperative infectinos and cs infections specifically, I could not come up with nor find a rational reason to wait until after cord clamp if the idea was to prevent surgical infection. For gyn surgery, most commonly these are given 30 minutes before the case. Can someone help with a reason for the difference? >> The original surgical research indicated the best results if antibiotics were given before incision. This is obviously the accepted way to do it, even today. In C-secions who are NOT already infected, it should be the same procedure. However, over the years the Pediatricians have bitched and complained that a baby with antibiotics on board at delivery MUST have a "full" course of antibiotics "just in case," since cultures will be "unreliable" due to interference by antibiotics. Therefore, giving someone a gram of cefazolin (or whatever) before a C-section often doomed a baby to a 10 day course of amp&gent or whatever the broad-spectrum coverage du jour was in the nursery. Soooooo, to get around the (less than scientifically reasonable) actions of the pediatricians, we started giving the antibiotics (prophylaxis, not treatment) AFTER the cord was clamped, to make sure that the baby didn't get any and the pediatricians wouldn't go overboard. That practice has persisted to this day. Interestingly, when a mother gets prophylactic AMPICILLIN (or penicillin) in labor for GBS prevention, the pediatricians don't put them on 10 days of broad-spectrum coverage. So go figure. Joe P.
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