The Impact of Low Dose versus High Dose Antibiotic Prophylaxis Regimens on Surgical Site Infection Rates after Cesarean Delivery: Randomized Controlled Trial

Abstract Background: Cesarean section (CS) is one of the most common operations done in the obstetric ward, and its usage is rapidly rising. Surgical site infections (SSI) are a common consequence following a CS, and they are primarily responsible for increased maternal mortality and morbidity, as well as patient dissatisfaction, longer hospital stays, and greater treatment expenses. Aim of Study: The current study aimed to evaluate the impact of low-dose versus high-dose antibiotic prophylaxis regimens on surgical site infection rates after cesarean delivery. Patients and Methods: This randomized controlled trial was conducted at Matarya Teaching Hospital between Decem-ber 2021 and December 2022 A total of 380 pregnant women who attended for elective CS were enrolled and randomly assigned to two groups; group 1 “control group” received a low-dose regimen (1g) of cefazolin sodium and group 2 “study group” received a high-dose regimen (2g) 30 minutes before skin incision. Results: In the current study, there were no significant differences between both groups as regards age, parity, and BMI. However, we demonstrated that higher parity, older age, and obesity were significantly associated with a high rate of wound infection. In our study, the median duration of CS was 60 minutes and the minimum is 25 minutes and the maximum is 90 minutes in both groups. We found that longer surgical duration is associated with a high rate of wound infection. In the present study, there were no significant differences between groups as regards previous medical history, including bronchial asthma, chronic hypertension, gestational hyperten-sion, and hypothyroidism. Also, no significant relation was noted between the patient's medical diseases and wound infection. Concerning Southampton follow-up scoring system grades in the present study (wound healing, bruising, erythema, hematoma formation, and inflammation); there were no sig-nificant differences between both groups as regard 24 hours, one week, and 30 days after surgery, p=0.968, 0.343 and 0.438 respectively. Also, there were no significant differences between both groups as regard wound infection 24 hours, 1 week, and 30 days after surgery, p=0.707, 0.093, and 0.492 respectively. Conclusion: We concluded that low-dose antibiotic is as efficacious as high-dose antibiotic prophylaxis regimens on surgical site infection rates after cesarean delivery. Current ACOG guidelines should be followed until further level I clinical trial evidence is available.