Antibiotic prophylaxis for cesarean birth

A single dose of each antibiotic is usually sufficient. An additional intraoperative dose of cefazolin is reasonable in patients with postpartum hemorrhage >1500 mL and for the rare complicated cesarean birth that extends beyond four hours (or two half-lives of the drug). An additional intraoperative clindamycin dose is reasonable in patients with postpartum hemorrhage >1500 mL and for the very rare complicated cesarean birth that extends beyond six hours. Gentamicin and azithromycin are not repeated intraoperatively.

AdjBW: adjusted body weight; IBW: ideal body weight; IV: intravenous.

* Signs and symptoms of immediate reactions include flushing, pruritus, urticaria, angioedema, bronchospasm, laryngeal edema, gastrointestinal symptoms, and hypotension. Refer to UpToDate content on penicillin allergy for detailed information.

¶ For patients whose weight is 1 to 1.25 times their ideal body weight (IBW), we typically use IBW to calculate dose. For patients whose weight is >1.25 times their IBW, we use the adjusted body weight (AdjBW). Refer to UpToDate content on parenteral dosing of aminoglycosides for detailed information. A calculator for IBW and AdjBW is available in UpToDate.

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Antibiotic prophylaxis for cesarean birth