Is Ancef (Cefazolin) administered post cesarean section?

From the Guidelines

Yes, cefazolin (Ancef) is typically given as prophylactic antibiotic for cesarean deliveries, with a recommended dose of 2 grams IV administered within 60 minutes before skin incision, as supported by high-quality evidence from the American Journal of Obstetrics and Gynecology 1.

Key Points

• The standard regimen for cefazolin is a single dose of 2 grams IV, which may be increased to 3 grams for patients weighing more than 120 kg.
• For cesareans lasting more than 3 hours or with blood loss exceeding 1500 mL, an additional dose of cefazolin may be warranted.
• Cefazolin is preferred due to its excellent coverage against common skin flora and genital tract organisms, as well as its ability to achieve high tissue concentrations at the surgical site.
• For patients with beta-lactam allergies, alternatives include clindamycin plus gentamicin or azithromycin, as recommended by the Enhanced Recovery After Surgery Society 1.
• Prophylactic antibiotics should be given preoperatively rather than after cord clamping, as this timing has been shown to reduce infection rates without increasing neonatal risks, according to the guidelines for intraoperative care in cesarean delivery 1.

Rationale

The use of prophylactic antibiotics in cesarean deliveries is supported by high-quality evidence, which demonstrates a significant reduction in postoperative infections, including endometritis and wound infections 1. Cefazolin is the recommended antibiotic due to its broad-spectrum coverage and ability to achieve high tissue concentrations at the surgical site. The timing of antibiotic administration is also crucial, with preoperative administration being preferred to reduce infection rates without increasing neonatal risks.

Additional Considerations

• The addition of azithromycin to conventional antibiotic prophylaxis may significantly reduce surgical site infections, as suggested by the guidelines for antibioprophylaxis in surgery and interventional medicine 1.
• Patients with beta-lactam allergies require alternative antibiotic regimens, such as clindamycin plus gentamicin or azithromycin, to ensure adequate prophylaxis against postoperative infections.

From the FDA Drug Label

When cefazolin has been administered prior to caesarean section, drug levels in cord blood have been approximately one quarter to one third of maternal drug levels. The drug appears to have no adverse effect on the fetus

• Cefazolin administration: The FDA drug label does provide information about cefazolin administration prior to caesarean section.
• Key finding: Cefazolin appears to have no adverse effect on the fetus when administered prior to caesarean section.
• Decision: Based on the information provided, yes, cefazolin (Ancef) can be given post cesarean, but the decision to administer should be based on a proven or strongly suspected bacterial infection or a prophylactic indication 2.

From the Research

Administration of Ancef Post Cesarean

• The use of cefazolin (Ancef) as a prophylactic antibiotic post cesarean delivery is supported by several studies 3, 4.
• A study published in the American journal of obstetrics & gynecology MFM found that preoperative cefazolin rather than clindamycin or metronidazole is associated with lower postpartum infection among women with chorioamnionitis delivering by cesarean delivery 3.
• Another study published in Obstetrics and gynecology found that the use of standard alternative antibiotics (clindamycin and gentamicin) compared with cefazolin was not associated with increased odds of surgical site infection, but the use of inappropriate alternative antibiotics was associated with increased odds of surgical site infections compared with cefazolin 4.
• The safety of administering cefazolin in penicillin-allergic patients for surgical prophylaxis has also been evaluated, and studies have found that it appears to be safe 5, 6.
• A study published in the journal Surgery found that administration of cefazolin in penicillin-anaphylactic patients for surgical prophylaxis appears to be safe, with no episodes of severe allergic reactions reported 6.

Comparison with Other Antibiotics

• Cefazolin has been compared with other antibiotics, such as clindamycin and metronidazole, in terms of its effectiveness in preventing surgical site infections post cesarean delivery 3, 4, 7.
• A study published in the American journal of obstetrics and gynecology found that the combination of cefazolin plus metronidazole was more effective in preventing surgical site infections after hysterectomy compared with cefazolin or second-generation cephalosporin alone 7.
• Another study published in the American journal of obstetrics & gynecology MFM found that cefazolin rather than clindamycin or metronidazole was associated with lower postpartum infection among women with chorioamnionitis delivering by cesarean delivery 3.