Re: Prophylactic antibiotics at csection

From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Fri Mar 26 07:30:24 2004


And I believe that studies have shown that wound infection rates for C/S are pretty much the same if the antibiotics are given BEFORE the case or AFTER cord clamping.

I have heard the argument that dosing beforehand allows a bit of transmission of the antibiotic (again, usually 1 gram of Cefazolin) and that a baby will occasionally get antibiotic associated diarrhea from it and get very sick. But, I've also heard that it could be from the antibiotic in the breast milk, so go figure.

Garry

>
>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.

--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA




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