Efficacy and safety of broad spectrum penicillin with or without beta-lactamase inhibitors vs first and second generation cephalosporins as prophylactic antibiotics during cesarean section: a systematic review and meta-analysis

Figures & data

Figure 1. Study flow diagram.

Table 1. Characteristics of the nine studies included in the systematic review.

Study	Type of study	Number of participants	Intervention	Dose and timing of administration	Outcomes
Bracero (1997)	Double-blinded RCT	170	Ampicillin/sulbactam 1.5 g	Single dose, IV, at time of umbilical cord clamping	Endometritis; wound infection; urinary tract infection; febrile morbidity; maternal rashes
			Cefotetan 1 g
Noyes et al. (1998)	RCT	292	Ampicillin/sulbactam 1.5 g	Single dose, IV, after umbilical cord clamping	Endometritis; maternal rashes
			Cefazolin 1 g
			Cefotetan 1 g
Spinnato et al. (2000)	Double-blinded RCT	298	Ampicillin/sulbactam 3 g	Single dose,IV, after umbilical cord clamping	Endometritis
			Ampicillin 2 g
			Cefotetan 2 g
Busowski et al. (2000)	Double-blinded RCT	75	Ampicillin/sulbactam 1.5 g	Single dose, IV, after umbilical cord clamping	Endometritis;wound infection;urinary tract infection
			Cefotetan 1 g
Ziogos et al. (2010)	Single-blinded RCT	176	Ampicillin/sulbactam 3 g	Single dose, IV, after umbilical cord clamping	Wound infection; endometritis
			Cefuroxime 1.5 g
Jyothi et al. (2010)	RCT	122	Amoxycillin-clavulanic acid 2.4 g	Single dose, IV, after umbilical cord clamping	Endometritis;wound infection
			Cefazolin 2 g
Mivumbi et al. (2014)	Single-blinded RCT	132	Ampicillin 2 g	Single dose, IV, no more than 60 min prior to skin incision.	Endometritis;wound infection;urinary tract infection; length of postoperative stay
			Cefazolin 1 g
Zhang et al. (2010)	RCT	673	Ampicillin 2 g	Multiple-day regimen, IV, no more than 60 min prior to skin incision, after surgery immediately and 6 h after surgery	Febrile morbidity; wound infection
			Cefazolin 1 g
Fang (2021)	RCT	60	Ampicillin 2 g	Single dose, IV, no more than 60 min prior to skin incision.	Wound infection
			Cefuroxime 1.5 g

Figure 2. Risk of bias summary.

Figure 3. Risk of bias graph.

Figure 4. Forest plots of the incidence of endometritis (A), wound infection (B), urinary tract infection (C) and maternal rashes (D) comparing P2+ with C1&C2.

Figure 5. Forest plots of the incidence of endometritis (A), febrile morbidity (B) and wound infection (C) comparing P2 with C1&C2.

Figure 6. Subgroup analysis of the incidence of wound infection comparing P2 with C1&C2 according to subclasses of cephalosporins, region, dosage regimen (A) and a forest plot was obtained after the removal of one article from heterogeneous sources (B).

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Data availability statement

All data in relation to this study are presented in this manuscript.