Medical mythology: Antibiotics for C-section – when?

This clinical question comes from Dr Tim (KI Docs).

He got talking to some specialist O&G and Anaesthesia docs about the timing of prophylactic ABs for LUSCS.  Doesn’t ssound too controversial – but it is one of those ‘memes’ of medicine that persist even well after the evidence is in and accounted for with clear benefits demonstrated.

When do you squirt in your IV ABs if you are doing an anaesthetic for LUSCS?

  • The classic teaching is:  after the umbilical cord has been clamped
  • The new way of thinking – ideally give them 30 – 60 mins prior to the skin incision.
So when I was training in Anaesthesia I was taught to give them after clamping.  I don’t even remember asking “why?” – I just did it.  We would give them, then announce over the drapes we had done it – and the Obs doc would say thankyou and we would go back to small talk with the new mum. Everybody happy…. well maybe not
 
In 2007 Sullivan et al from South Carolina did this RCT which was pretty neat, comparing the two regimes for ABs – they found a decrease in the rate of infections, especially endometritis in the early AB group.  The kids all did the same – no change in neonatal outcomes or the need for a sepsis screen.
 
I changed my practice a few years back when I did a refresher block in Anaesthesia in the big tertiary centre for Anaesthetics – basically i just changed because it seemed to be the done thing there – nobody said “hey, we’ve got evidence for this”.  This is how a lot of us ‘head down – bum up’ doctors get out info, no time to look around – just keep doing what we do until someboby tells us different.
 
Have you got any other memes / myths that need busting?  Let me know
Casey
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