Medical mythology: Antibiotics for C-section – when?
October 26, 2011
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
About The Author
Casey Parker
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact
2 Comments
This issue stirred up a lot of conflict when it was introduced at my hospital. The main gripe is the anaphylaxis risk. In our departmental meeting of about 30 anaesthetists, 2 of my colleagues had experienced anaphylaxis before the baby was delivered. All for a drug which has ‘no’ anaesthetic relevance to reduce a risk that can be reduced by proper allocation of time for the alcoholic chlorhexidine to dry! Furthermore the best time to administer antibiotics is controversial and there is a strong case that the patients should receive it prior to coming to theatre!
Hi HL
The IV Abs look like they do definitely confer a ‘risk reduction’ to the mother – I think the use of chlorhex etc is all good, routine care but the IV Abs show a definite decrease in mortality – independent of the rest.
I completely agree – maybe they should be given on the labour ward 30 minutes prior t incision – that is the suggested protocol – once the decision to go to CS is made.
However, the rare risk of anaphylaxis is there – but surely it is better this occur in a fully stocked / staff OT, than on the ward in the dark with a single midwife in attendance?
I refute the idea of “anaesthetic relevance” – maybe I am an idealist – but I am interested in patient outcomes, and I think the study presented supports the idea of IV ABs early – either on the ward or at least once in the OT.
Does anybody else have a different opinion