## Antibiotic Prophylaxis in Cesarean Section **Key Point:** Cefazolin is the first-line antibiotic for surgical site infection prophylaxis in cesarean delivery, regardless of indication (elective or emergency). ### Mechanism & Rationale Cefazolin is a first-generation cephalosporin that provides: - Broad coverage against gram-positive cocci (Staphylococcus aureus, Streptococcus species) - Adequate coverage against gram-negative organisms (E. coli, Klebsiella) - Excellent tissue penetration into the uterus and amniotic fluid - Cost-effectiveness and safety profile in pregnancy ### Dosing in Cesarean Section | Parameter | Details | |-----------|----------| | **Standard dose** | 1–2 g IV at time of skin incision | | **Redosing** | Every 2 hours during prolonged surgery (>2 hours) | | **Timing** | Within 60 minutes before incision (120 min if vancomycin/clindamycin) | | **Duration** | Single preoperative dose; redose only if surgery prolonged | ### Penicillin Allergy Considerations - **Non-anaphylactic allergy (rash):** Cefazolin safe; cross-reactivity <2% - **Anaphylactic allergy:** Use clindamycin 600 mg IV or vancomycin 15–20 mg/kg IV **High-Yield:** Cefazolin is preferred over second/third-generation cephalosporins because it achieves adequate amniotic fluid levels and has superior gram-positive coverage for the most common pathogens (group B Streptococcus, S. aureus). **Clinical Pearl:** In cesarean delivery, antibiotic prophylaxis is given to the mother (not the neonate) and reduces surgical site infection by ~60% compared to no prophylaxis. ### Why Not Other Agents? - **Clindamycin:** Reserved for penicillin-allergic patients; inferior gram-negative coverage - **Metronidazole:** Anaerobic coverage only; inadequate for gram-positive organisms - **Gentamicin:** Aminoglycoside; poor amniotic fluid penetration and risk of fetal ototoxicity; not first-line
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.