Re: Cefzolin debate
From: art fougner, md (evsono@pipeline.com)
Sun Aug 12 08:36:00 2007
Medicine swings like a pendulum do - apologies to Roger Miller.
Art
At Sun, 12 Aug 2007, Efrain Ramirez wrote:
>
>I don’t think that this issue has been settled.. I give it after cord
>clamping.. I am willing to change, of course, but, IMHO, more RCT
>studies are needed.... I personally believe that it doesn’t make any
>difference to the mother – I am not too sure about the baby.
>
>Ef
>
>> At Sat, 11 Aug 2007, RModugno@aol.com wrote:
>>
>>Controversy in our practice rages over giving prophylactic cefzolin prior to
>>incision at C/S or after cord clamping.
>>
>>I give it prior to incision in keeping with guidelines for general or GYN
>>surgery.
>>
>>This article has helped my cause:
>>
>> Administration of Cefazolin Prior to Skin Incision is Superior to Cefazolin
>>at Cord Clamping in Preventing Post-Cesarean Infectious Morbidity
>>_Scott Sullivan_
>>(http://www.obgyn.net/smfm2007/index.cfm?dynpage=CVs/Scott_Sullivan) 1, Triz Smith2, Eugene Chang1, Thomas Hulsey3, J. Van Dorsten1,
>>David Soper1,
>>
>>1Medical University of South Carolina, Obstetrics and Gynecology,
>>Charleston, South Carolina, 2Medical University of South Carolina,
>>Obstetrics/Gynecology, Charleston, South Carolina, 3Medical University of South Carolina,
>>Pediatrics, Charleston, South Carolina
>>Abstract
>>Objective: The objective of this study was to determine whether the
>>administration of Cefazolin prior to skin incision was superior to administration at
>>the time of umbilical cord clamping for the prevention of post-cesarean
>>infectious morbidity.
>>Study Design: This was a prospective, randomized, double-blind
>>placebo-controlled trial. Study subjects received 1 gram of Cefazolin at least 15 minutes
>>prior to skin incision. Control subjects received the same antibiotic at the
>>time of cord clamping. Subjects were followed for the occurrence of
>>endomyometritis, wound infection and other infectious morbidity. Neonatal outcomes
>>were collected for occurrence of sepsis, septic workups and length of stay.
>>Results: 367 subjects were enrolled in the trial and 357 completed follow
>>up. There were no demographic differences observed between the study and
>>control groups including age (p = 0.87), race (p = 0.8) or insurance (p = 0.86).
>>There were no differences seen in clinical variables between groups including
>>diabetes (p = 0.1), weight (p = 0.49) or indication for cesarean. There was
>>decreased total infectious morbidity in the study group [RR = 0.4, 95 % CL
>>0.18-0.87], decreased endometritis [RR = 0.2 95 % CL 0.15-0.94] and a trend
>>toward decreased wound infections [RR = 0.52 95 % CL 0.18-1.5]. No increase in
>>0.2) was observed in the study group.
>>Conclusion: Administration of prophylactic Cefazolin prior to skin incision
>>resulted in a decrease in both endomyometritis and total post-cesarean
>>infectious morbidity compared to administration of the same dose at the time of
>>cord clamping. This dosing did not result in increased neonatal sepsis, septic
>>workup or admission days.
>>American Journal of Obstetrics and Gynecology
>>_Volume 195, Issue 6, Supplement S (December 2006)_
>>(http://www.ajog.org/issues/contents?issue_key=TOC@@JOURNALS@YAJOG@0195@0006s0)
>>*******************************************
>>What do you folks do?
>>*******************************************
>>*******************************************
>>
>>Robert Modugno MD MBA FACOG
>>Sylva, NC
>>
>>************************************** Get a sneak peek of the all-new AOL at
>
>--
>“ The greatest obstacle to knowledge is not ignorance,
>it is the illusion of knowledge.” Daniel J. Boorstin - Historian
>
--
art fougner, md
"May The Wings of Liberty Never Lose a Feather." - Jack Burton
