Different classes of antibiotics given to women routinely for preventing infection at caesarean section

Myfanwy J Williams; Carolina Carvalho Ribeiro do Valle; Gillian ML Gyte

doi:10.1002/14651858.CD008726.pub3

Cochrane Database of Systematic Reviews

Administración sistemática de diferentes clases de antibióticos a las mujeres para la prevención de la infección en la cesárea

Información

DOI:

https://doi.org/10.1002/14651858.CD008726.pub3 Copiar DOI

Base de datos:

Cochrane Database of Systematic Reviews

Versión publicada:

04 marzo 2021see what's new

Tipo:

Intervention

Etapa:

Review

Grupo Editorial Cochrane:

Grupo Cochrane de Embarazo y parto

Copyright:

Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

Altmetric:

Citado por:

Citado 0 veces por enlace Crossref Cited-by

Contraer

Autores

Myfanwy J Williams

Correspondencia a: Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK

[email protected]
Carolina Carvalho Ribeiro do Valle

Infection Prevention and Control, Hospital da Mulher Prof. Dr. José Aristodemo Pinotti - CAISM, Department of Obstetrics and Gynaecology, University of Campinas, Campinas, Brazil
Gillian ML Gyte

Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK

Contributions of authors

For the 2020 update, Gill Gyte (GG) and Myfanwy Williams (MW) undertook the data extraction, GG entered the data, and MW checked this. MW drafted the 'Summary of findings' table, and all assessments were checked and agreed with GG. MW and GG drafted all other text. Carolina Carvalho Ribeiro do Valle (CV) provided expert guidance on the structural revisions for this update, and helped to draft text explaining these revisions. CV also advised on the content of the background section and updated information about different types of antibiotics. GG, MW and CV reviewed and agreed all discussion sections and review conclusions.

Sources of support

Internal sources

The University of Liverpool, UK

External sources

World Health Organization (WHO) and the UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Switzerland, Switzerland

This review is supported by funding to Cochrane Pregnancy and Childbirth (University of Liverpool)

Declarations of interest

Gillian ML Gyte: GG received royalties from John Wiley & Sons in respect of ‘A Cochrane Pocketbook – Pregnancy and Childbirth’ Hofmeyr GJ et al. 2008.

Myfanwy J Williams: is employed by the University of Liverpool as a Research Associate at Cochrane Pregnancy and Childbirth. Her role is supported by the World Health Organization.

Carolina Carvalho Ribeiro do Valle: none known.

Acknowledgements

We wish to thank Laura Hopkins and Fiona Smaill for all their work on the original version of this review, Lixia Dou, and Juan Vazquez for their work on previous updates, and Erika Ota for her contribution to earlier versions of the review. Also, we would like to thank Tim Neal for providing guidance on earlier updating of this review, and Neil Hotham and Wendy Jones who provided earlier guidance on the classification of the antibiotics. Also our thanks to Zarko Alfirevic for his contribution to previous versions of the review, particularly in helping to develop the structure and interpret the data, and to Joshua Vogel for suggesting the concept of Table 2 (comparison matrix).

Thanks to Austin Anderson Leirvik for translating Fugere 1983; Anne‐Marie Grant for translating Luttkus 1997; Danping He for translating Xu 1997; Alison Jenner for translating Warnecke 1982; Andrew MacDonald for translating Voto 1986; Cathryn Siegel‐Bergman for translating Koppel 1992; Tamara Stampalija for translating Mansani 1984 and Mansueto 1989; Caroline Summers for translating Wagner 2006; and Elizabeth Whiteley for translating Patacchiola 2000 and Rosaschino 1988.

This review is supported by funding from the UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) to Cochrane Pregnancy and Childbirth (University of Liverpool). HRP supports and coordinates research on a global scale, synthesizes research through systematic reviews of literature, builds research capacity in low‐ and middle‐income countries and develops dissemination tools to make efficient use of ever‐increasing research information. In addition to its cosponsors, the International Planned Parenthood Federation (IPPF) and UNAIDS are both members of HRP’s governing body.

As part of the pre‐publication editorial process, two peers (an editor and referee who is external to the editorial team) commented on this review, as well as a member of Cochrane Pregnancy and Childbirth's international panel of consumers and the Group's Statistical Adviser. The authors are grateful to the peer reviewer who wishes to remain anonymous.

This project was supported by the National Institute for Health Research (NIHR), via Cochrane Infrastructure funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Evidence Synthesis Programme, the NIHR, National Health Service (NHS) or the Department of Health and Social Care.

Version history

Published

Title

Stage

Authors

Version

2021 Mar 04

Different classes of antibiotics given to women routinely for preventing infection at caesarean section

Review

Myfanwy J Williams, Carolina Carvalho Ribeiro do Valle, Gillian ML Gyte

https://doi.org/10.1002/14651858.CD008726.pub3

2014 Nov 17

Different classes of antibiotics given to women routinely for preventing infection at caesarean section

Review

Gillian ML Gyte, Lixia Dou, Juan C Vazquez

https://doi.org/10.1002/14651858.CD008726.pub2

2010 Oct 06

Different classes of antibiotics given to women routinely for preventing infection at caesarean section

Review

Zarko Alfirevic, Gillian ML Gyte, Lixia Dou

https://doi.org/10.1002/14651858.CD008726

Differences between protocol and review

From the original protocol, this review has been separated into three reviews as described in the updated protocol sections of this review and a further two reviews will provide information on this topic.

Different classes of antibiotics given to women routinely for preventing infection after caesarean section (this review)
Different regimens of penicillin antibiotic given to women routinely for preventing infection after caesarean section (vacant title)
Different regimens of cephalosporin antibiotic given to women routinely for preventing infection after caesarean section (vacant title)
Timing of intravenous prophylactic antibiotics for preventing postpartum infectious morbidity in women undergoing caesarean delivery (Mackeen 2014)
Routes of administration for antibiotic given to women routinely for preventing infection after caesarean section (Nabhan 2016)

Change in definition of caesarean subgroups in 2020 update

We intended to revise the definition of type of caesarean surgery by urgency in line with RCOG definitions, due to the fact that other infection control measures are compromised in the most urgent surgeries. However, there was inadequate information in the available trial reports to support this planned revision.

Removal of subgroup analyses in 2020 update
We have deleted subgroup analyses by timing of administration because these issues are investigated in Mackeen 2014. We have also removed subgroup analyses by route of administration because this is investigated in Nabhan 2016. However, we have analysed trial administering antibiotics systemically separately from those using lavage/irrigation (see note below).

Separation of results from trials using lavage from those administering different classes of antibiotics systemically

For this update, we did not pool results from two trials that gave women antibiotics via lavage with results from trials administering them systemically (usually IV), because antibiotics penetrate tissues very differently in each case. The intravenous route allows the antibiotic to penetrate not only the endometrium, but also the skin, the fat tissues beneath it the muscles and the uterus as a whole, and also the urinary tract.

Revised analyses of cephalosporins and penicillins in 2020 update
The main causative agents of caesarean section infection are skin colonizers, primarily gram‐positive cocci (particularly including Staphylococcus aureus and Streptococci); and vaginal colonizers, including anaerobes and, to a lesser extent, gram‐negative bacilli. In the previous update of this review, the main comparison was between cephalosporins and penicillins. For this update, we have not pooled the data for all penicillins or for all cephalosporins, because of important variations in spectra of action between different sub‐classes of both of these classes of drugs (including different generations of cephalosporins, types of penicillins, and co‐formulations of both classes). Where sub‐classes of these drugs are known to differ in their potential to act against agents that are the principle causes of infection at caesarean section, we have meta‐analysed the results of trials of different sub‐classes separately. Where sub‐classes of drugs are known to have similar potential action against these agents, we have pooled the results.

Revised main comparisons

In the previous update of this review, the main comparison was between cephalosporins and penicillins. We have revised our main comparisons to reflect trends in global practice, to include the following.

Cephalosporins C1 and C2 (1^st and 2^nd generation) versus lincosamides (especially clindamycin)
Cephalosporins C1 and C2 (1^st and 2^nd generation) versus lincosamides (especially clindamycin) plus aminoglycosides (especially gentamicin)
Cephalosporins C1 and C2 (1^st and 2^nd generation) versus penicillins P2+ (broad spectrum penicillins plus betalactamase inhibitors)

Revised outcomes
We have added two further outcomes 'Post‐discharge infections ‐ to 30 days' and 'Maternal readmissions to hospital'. We have removed the outcome 'Development of antibacterial resistance', because bacterial resistance is unlikely to be detected by randomised controlled trials (RCTs). Other types of trial are more appropriate for investigating this outcome.

Search
For the 2020 update, we added in an additional search of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP).

Notes

The Hopkins 1999 published review on, Antibiotic prophylaxis regimens and drugs for caesarean section, has been subsequently ‘withdrawn’ from publication in the Cochrane Library because it has become out of date. The review has now been split into five separate reviews.

Different classes of antibiotics given to women routinely for preventing infection at caesarean section (this review)
Different regimens of penicillin antibiotics given to women routinely for preventing infection after caesarean section (vacant title)
Different regimens of cephalosporin antibiotic prophylaxis at caesarean section for reducing morbidity (vacant title)
Timing of prophylactic antibiotics for preventing infectious morbidity in women undergoing caesarean section (Mackeen 2014)
Routes of administration of antibiotic prophylaxis for preventing infection after caesarean section (Nabhan 2016)

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Female; Humans; Infant, Newborn; Pregnancy;

PICO

Population

Intervention

Comparison

Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Methodological quality summary: review authors' judgements about each methodological quality item for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 1: Maternal sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 2: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 3: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 4: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 5: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 6: Maternal composite adverse effects

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 7: Maternal allergic reactions

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 8: Maternal skin rash

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS, Outcome 1: Maternal sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS, Outcome 2: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by generation of cephalosporin, Outcome 1: Maternal sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by generation of cephalosporin, Outcome 2: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.2

Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 2: Sensitivity analysis (Fixed effects) Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.3

Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 3: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.4

Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 4: Subgroup analysis by type of cephalosporin Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.5

Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 5: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.6

Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 6: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.7

Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 7: Maternal composite adverse effects

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.8

Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 8: Maternal allergic reactions

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.9

Comparison 4: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 9: Maternal length of hospital stay (days)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.1

Comparison 5: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.1

Comparison 6: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by generation of cephalosporin, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 7.1

Comparison 7: Antistaphylococcal cephalosporins C1 and C2 (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.1

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 1: Maternal sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.2

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 2: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.3

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 3: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.4

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 4: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.5

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 5: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.6

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 6: Maternal composite serious infectious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.7

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 7: Maternal composite adverse effects

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.8

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 8: Maternal allergic reactions

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.9

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 9: Maternal nausea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.10

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 10: Maternal vomiting

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.11

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 11: Maternal diarrhoea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 8.12

Comparison 8: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes, Outcome 12: Maternal skin rash

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.1

Comparison 9: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS, Outcome 1: Maternal sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 9.2

Comparison 9: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS, Outcome 2: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 10.1

Comparison 10: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin, Outcome 1: Maternal sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 10.2

Comparison 10: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin, Outcome 2: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.1

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.2

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 2: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.3

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 3: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.4

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 4: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.5

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 5: Maternal composite serious infectious complication

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.6

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 6: Maternal composite adverse effects

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.7

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 7: Maternal allergic reactions

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.8

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 8: Maternal nausea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.9

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 9: Maternal vomiting

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.10

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 10: Maternal diarrhoea

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.11

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 11: Maternal skin rash

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 11.12

Comparison 11: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes, Outcome 12: Maternal length of hospital stay

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 12.1

Comparison 12: Minimally antistaphylococcal cephalosporins C3 (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 13.1

Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 13.2

Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 2: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 13.3

Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 3: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 13.4

Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 4: Maternal vomiting

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 13.5

Comparison 13: Other cephalosporin (only) regimens vs other penicillin (only) regimens, Outcome 5: Maternal skin rash

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 14.1

Comparison 14: Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+, Outcome 1: Maternal sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 14.2

Comparison 14: Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+, Outcome 2: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 14.3

Comparison 14: Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+, Outcome 3: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 14.4

Comparison 14: Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+, Outcome 4: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 15.1

Comparison 15: Fluoroquinolones F vs cephalosporins C2 (2^nd generation), Outcome 1: Maternal sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 15.2

Comparison 15: Fluoroquinolones F vs cephalosporins C2 (2^nd generation), Outcome 2: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 15.3

Comparison 15: Fluoroquinolones F vs cephalosporins C2 (2^nd generation), Outcome 3: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 15.4

Comparison 15: Fluoroquinolones F vs cephalosporins C2 (2^nd generation), Outcome 4: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 16.1

Comparison 16: Carbapenems Ca vs cephalosporins C3 (3^rd generation), Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 16.2

Comparison 16: Carbapenems Ca vs cephalosporins C3 (3^rd generation), Outcome 2: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 16.3

Comparison 16: Carbapenems Ca vs cephalosporins C3 (3^rd generation), Outcome 3: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 16.4

Comparison 16: Carbapenems Ca vs cephalosporins C3 (3^rd generation), Outcome 4: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 17.1

Comparison 17: Macrolides M vs cephalosporins C1 (1^st generation), Outcome 1: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 18.1

Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 18.2

Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 2: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 18.3

Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 3: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 18.4

Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 4: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 18.5

Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 5: Maternal length of hospital stay (days)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 18.6

Comparison 18: Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens, Outcome 6: Costs

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 19.1

Comparison 19: Other antibiotic regimens (multiple classes) vs penicillin (only) regimens, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 19.2

Comparison 19: Other antibiotic regimens (multiple classes) vs penicillin (only) regimens, Outcome 2: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 19.3

Comparison 19: Other antibiotic regimens (multiple classes) vs penicillin (only) regimens, Outcome 3: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 19.4

Comparison 19: Other antibiotic regimens (multiple classes) vs penicillin (only) regimens, Outcome 4: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 20.1

Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 1: Maternal sepsis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 20.2

Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 2: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 20.3

Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 3: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 20.4

Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 4: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 20.5

Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 5: Maternal urinary tract infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 20.6

Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 6: Maternal composite adverse effects

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 20.7

Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 7: Maternal length of hospital stay

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 20.8

Comparison 20: Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes), Outcome 8: Costs

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 21.1

Comparison 21: (Irrigation/lavage) cephalosporins vs penicillins, Outcome 1: Maternal endometritis

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 21.2

Comparison 21: (Irrigation/lavage) cephalosporins vs penicillins, Outcome 2: Maternal fever (febrile morbidity)

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 21.3

Comparison 21: (Irrigation/lavage) cephalosporins vs penicillins, Outcome 3: Maternal wound infection

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings 1. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) compared to broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes for preventing infection at caesarean section

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) compared to broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes for preventing infection at caesarean section
Patient or population: all women undergoing caesarean section Setting: Hospital (Greece, India, Thailand, USA) Intervention: antistaphylococcal cephalosporins 1st and 2nd generation (C1 and C2) Comparison: broad spectrum penicillins plus betalactamase inhibitors (P2+)
Outcomes	Risk with broad spectrum penicillins plus betalactamase inhibitors (P2+)	Risk with Antistaphylococcal cephalosporins (1st and 2nd generation (C1 and C2)	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Maternal sepsis	Study population		RR 2.37 (0.10 to 56.41)	75 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
Maternal sepsis	0 per 1000	0 per 1000 (0 to 0)	RR 2.37 (0.10 to 56.41)	75 (1 RCT)	⊕⊝⊝⊝ VERY LOW ^{1 2}
Maternal endometritis	Study population		RR 1.10 (0.76 to 1.60)	1161 (7 RCTs)	⊕⊕⊝⊝ LOW ^{1 3}
Maternal endometritis	78 per 1000	86 per 1000 (60 to 125)	RR 1.10 (0.76 to 1.60)	1161 (7 RCTs)	⊕⊕⊝⊝ LOW ^{1 3}
Infant sepsis	Study population		‐	(0 studies)	‐	No included studies reported on this outcome
Infant sepsis	see comment	see comment	‐	(0 studies)	‐	No included studies reported on this outcome
Infant oral thrush	Study population		‐	(0 studies)	‐	No included studies reported on this outcome
Infant oral thrush	see comment	see comment	‐	(0 studies)	‐	No included studies reported on this outcome
Maternal wound infection	Study population		RR 0.78 (0.32 to 1.90)	543 (4 RCTs)	⊕⊝⊝⊝ VERY LOW ^{4 5}
Maternal wound infection	38 per 1000	29 per 1000 (12 to 71)	RR 0.78 (0.32 to 1.90)	543 (4 RCTs)	⊕⊝⊝⊝ VERY LOW ^{4 5}
Maternal urinary tract infection	Study population		RR 0.64 (0.11 to 3.73)	496 (4 RCTs)	⊕⊝⊝⊝ VERY LOW ^{6 7 8}
Maternal urinary tract infection	51 per 1000	33 per 1000 (6 to 190)	RR 0.64 (0.11 to 3.73)	496 (4 RCTs)	⊕⊝⊝⊝ VERY LOW ^{6 7 8}
Maternal composite adverse effects	Study population		RR 0.96 (0.09 to 10.50)	468 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^{4 5}
Maternal composite adverse effects	5 per 1000	5 per 1000 (0 to 56)	RR 0.96 (0.09 to 10.50)	468 (2 RCTs)	⊕⊝⊝⊝ VERY LOW ^{4 5}
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio.
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.
¹ All of pooled effect provided by study or studies at moderate risk of selection bias. Downgrade ‐1. ² Single study with small sample size and few events. Wide confidence interval including both appreciable reduction and appreciable increase in risk with antistaphylococcal (1st and 2nd generation) cephalosporins. The reported data are for bacteriaemia, not sepsis. Although bacteriaemia is usually accompanied by sepsis, there is the possibility of indirectness for this outcome. Downgrade ‐2. ³ Wide confidence interval including appreciable increase in risk with antistaphylococcal (1st and 2nd generation) cephalosporins, whilst also including no difference in effect. Downgrade ‐1. ⁴ Majority of pooled effect provided by studies at moderate risk of selection bias or detection bias. Downgrade ‐1. ⁵ Few events. Wide confidence interval including both appreciable reduction and appreciable increase in risk with antistaphylococcal (1st and 2nd generation) cephalosporins. Downgrade ‐2. ⁶ Majority of pooled effect provided by studies at moderate risk of bias due to lack of information about random sequence generation and concealment of allocation. Downgrade ‐1. ⁷ Severe unexplained statistical heterogeneity (I² = 66%, P value for Chi² test = 0.05). Downgrade ‐1. ⁸ Few events. Downgrade ‐1.

Summary of findings 1. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) compared to broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes for preventing infection at caesarean section

Ir a la tabla de la revisión

Table 1. Classification of antibiotics

Penicillins (P)
Penicillins consist of a thiazolidine ring connected to a B‐lactam ring to which is attached to a side chain. The penicillin nucleus itself is the chief structural requirement for biological activity. Penicillins are the oldest class of antibiotics and function by inhibiting cell wall synthesis (bactericidal).
Class or sub‐class name and detail	Examples	Spectrum
Natural penicillins (P1) are based on the original penicillin‐G structure (also known as first‐generation penicillins)	Penicillin G (benzyl penicillin, crystalline penicillin); Procaine; Penicillin V; Benzathine.	Gram‐positive: non‐betalactamase producing gram‐positive cocci (including viridans streptococci, group A streptococci, Streptococcus pneumoniae, anaerobic Streptococcus), Enterococcus spp., non‐penicillinase producing strains of Staphylococcus aureus, coagulase negative Staphylococcus aureus, Clostridium spp. (excluding C. difficile), Actinomyces spp Gram‐negative:Neisseria meningitides, non‐penicillinase producing Neisseria gonorrhoea, Pasteurella multocida
Broad spectrum penicillins(P2) which are effective against a wider range of bacteria	Second‐generation penicillins: Aminopenicillins; Ampicillin; Amoxicillin.	Gram‐positive:Streptococcus spp, Enterococcus faecalis, Listeria monocytogenes. Gram negative:Escherichia coli, Proteus mirabilis, Salmonella, Shigella, e Haemophilus influenzae Anaerobes: Clostridium spp
	Third‐generation penicillins: Carbenicillin; Ticarcillin.	Gram‐positive: Streptococcus spp, Enterococcus faecalis, Listeria monocytogenes. Gram‐negative: Escherichia coli, Proteus mirabilis, Salmonella, Shigella, Haemophilus influenzae, Pseudomonas aeruginosa, Acinetobacter spp Anaerobes: Clostridium spp
	Fourth‐generation penicillins: Piperacillin; Mezlocillin.	Gram‐positive: Streptococcus spp, Enterococcus faecalis, Listeria monocytogenes, Staphylococcus aureus. Gram‐negative:Escherichia coli, Proteus mirabilis, Salmonella, Shigella, e Haemophilus influenzae Anaerobes: Clostridium spp, Bacteroides fragilis
Penicillins plus betalactamase inhibitors (P2+) are active against gram‐positive, gram‐negative and anaerobic bacteria, including S.aureus, Enterococci, Streptococci, many Enterobacterales and Bacteroides spp	Co‐amoxyclav = amoxicillin + clavulanic acid (Trade names include: Augmentin; Clavamox; Tyclav) Ampicillin + sulbactam (Trade names include: Ampictam; Unasyn) Timentin = ticarcillin + clavulanate	Gram‐positive: Streptococcus spp, Enterococcus faecalis, Listeria monocytogenes, Staphylococcus aureus. Gram‐negative:Escherichia coli, Proteus mirabilis, Salmonella, Shigella, e Haemophilus influenzae Anaerobes: Clostridium spp, Bacteroides fragilis
Antistaphylococcal penicillins(P3) are active even in the presence of the bacterial enzyme that inactivates most natural penicillins (also known as penicillinase‐resistant penicillins)	Cloxacillin; Dicloxacillin; Methicillin; Nafcillin; Oxacillin.	Staphylococcus aureus
Cephalosporins (C)
Cephalosporins have a similar basic structure to penicillins but with different side chains. They function by inhibiting cell wall synthesis.
First‐generation cephalosporins (C1)	Cephalothin; cefazolin; cephapirin; cephradine; cephalexin; cefadroxil.	Gram‐positive: (Streptococcus spp, Staphylococcus aureus) Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae Anaerobes: except Bacteroides
Second‐generation cephalosporins (C2)	Cefoxitin; cefaclor; cefuroxime; cefotetan; cefprozil; cefamandole, cefonicid; ceforanide, cefotiam.	Gram‐positive: (Streptococcus spp, Staphylococcus aureus) Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae. Anaerobes: including Bacteroides (Cephamycins)
Third‐generation cephalosporins (C3)	Cefotaxime; ceftizoxime; ceftriaxone; cefpodoxime; cefditoren; ceftibuten; ceftazidime; cefcapene; cefdaloxime; cefetamet; cefixime; cefmenoxime; cefodizime; cefoperazone; cefpimizole.	Gram‐negative: Enterobacterales, Neisseria spp, Haemophilus spp Gram‐positive: Streptococcus spp Anaerobes:Bacteroides fragilis, Clostridium spp, Peptostreptococcus spp, Prevotella sp
Fourth‐generation cephalosporins (C4)	Cefepime; cefpirome; cefclidine; cefluprenam; cefozopran; cefquinome.	Gram‐negatives: Enterobacterales, Neisseria spp, Haemophilus spp, Acinetobacter spp, Pseudomonas aeruginosa Gram‐positive:Staphylococcus aureus, Streptococcus spp
Cephalosporin plus betalactamase inhibitors (C+)	Ceftolozane‐tazobactam; ceftazidime‐avibactam.	Ceftolozane‐tazobactam Gram‐negative:Enterobacterales, P aeruginosa, Gram‐positive: limited activity against streptococci, general low activity against staphilococcal and enterococcal species. Ceftzidime‐avibactam extends the spectrum of ceftazidime against AmpC beta‐lactamase, ESBL and some specific carbapenemases
Other classes of antibiotics
Aminoglycosides (A) are first‐line therapy for a limited number of very specific, often historically prominent infections, such as plague, tularemia and tuberculosis. They are used to treat resistant infections caused by Gram‐negative bacilli	Streptomycin; gentamicin, kanamycin, amikacin.	Gram‐negative: Enterobacterales, Pseudomonas spp, Acinetobacter spp Synergism with beta‐lactams and glycopeptides Enterococcus spp and S. aureus
Amphenicols (Am) inhibit bacterial protein synthesis. Very rarely used nowadays.	Chloramphenicol	Chloramphenicol is considered to have similar action to tetracycline (see below).
Other beta‐lactams: carbapenems (Ca) Carbapenems are beta‐lactams that have a broader spectrum of activity than most other beta‐lactam antibiotics.	Examples include Imipenem; meropenem; ertapenem; aztreonam.	Gram‐negative: including Extended‐sectrum betalactamase producing bacteria (ESBL+), H. influenzae e N. gonorrhoeae, Enterobacterales, Acinetobacter spp, P. aeruginosa Gram‐positive: including Enterococcus faecalis, Listeria S. aureus Anaerobes: including B. fragilis
Fluoroquinolones (F) target the bacterial DNA gyrase and topoisomerase. They are potent bacteriocidal agents against a broad variety of micro‐organisms.	Ciprofloxacin; levofloxacin; lomefloxacin; norfloxacin; sparfloxacin; clinafloxacin; gatifloxacin; ofloxacin; trovafloxacin, maxifloxacin.	Gram‐negative: Enterobacterales, Pseudomonas spp, Acinetobacter spp Moxifloxacin and Levofloxacin: as above plus Streptococci
Lincosamides (L) are protein synthesis inhibitors which bind to the 50s subunit of bacterial ribosomes and inhibit early elongation of peptide chain by inhibiting transpeptidase reaction.	Lincomycin; clindamycin.	Gram‐positive aerobes and anaerobes, including S. Aureus and Streptococci, not Enterococci
Macrolides (M) inhibit bacterial protein synthesis. Resistance can arise.	Erythromycin; clarithromycin; azithromycin.	Streptococcus pneumoniae,S. aureus, Listeria monocytogenes, Neisseria spp, Chlamydia spp, Legionella spp, Haemophilus spp
Nitroimidazoles (N) Nitroimidazole is an imidazole derivative that contains a nitro group. It is used for the treatment of infection with anaerobic organisms.	Metronidazole; tinidazol.	Clostridium spp, Eubacterium spp, Peptococcus spp, Peptostreptococcus spp, Fusobacterium spp, Gardnerella, Mobiluncus, Trichomonas, Entamoeba spp
Tetracyclines (T) are bacteriostatic antibiotics active against a wide range of aerobes and anaerobic gram‐positive and gram‐negative bacteria. They inhibit bacterial protein synthesis by binding to the 30S bacterial ribosome. Tetracyclines should not be used with children under 8 and specifically during teeth development as they can cause a permanent brown discolouration to the teeth. This antibiotic is, therefore, unlikely to be used at caesarean section.	Tetracycline; doxycycline; minocycline.	Staphylococcus aureus, Streptococcus pneumonia, Streptococcus pyogenes, Streptooccus agalacticae, Campylobacter jejuni, Haemophilus influenzae, Neisseria gonorrhoeae, Neisseria meningitides,Clostridium spp., Peptostreptococcus spp., Peptococcus spp. Bacteroides melaninogenicus, Bacteroides fragilis
This table was originally adapted from information at https://www.emedexpert.com/classes/antibiotics.shtml, and has been revised for the 2020 update (Drew 2020; Letourneau 2020a; Letourneau 2020b; Letourneau 2020c; Letourneau 2020d; WHO 2020.

Table 1. Classification of antibiotics

Ir a la tabla de la revisión

Table 2. Comparison matrix

Intervention/comparison class or sub‐class of antibiotic		Single class administered			Multiple classes administered
		Antistaphylococcal cephalosporins (C1 and C2; 1^st and 2^nd generation)	Minimally antistaphylococcal cephalosporins (C3; 3^rd generation)	Broad spectrum penicillins plus betalactamase inhibitors (P2+)	Lincosamide (L) plus aminoglycoside (A)	Antistaphylococcal cephalosporins (C1 and C2; 1^st and 2^nd generation) plus nitroimadazole (N)	Aminoglycaside (A) plus nitroimidazole (N)	Minimally antistaphylococcal cephalosporins (C3; 3^rd generation) plus nitroimidazole (N)
Single class administered	Broad spectrum penicillins plus betalactamase inhibitors (P2+)	8 trials (1540 women)	2 trials (865 women)	Comparison not within scope of review	No trials	1 trial (83 women)	No trials	No trials
	Non‐antistaphylococcal penicillins (P1 and P2; natural and broad spectrum)	Systemic administration: 9 trials (3093 women) Lavage: 1 trial (383 women)	4 trials (854 women)	Comparison not within scope of review	1 trial (88 women)	1 trial (139 women)	No trials	No trials
	Broad spectrum penicillins (P2) and antistaphylococcal penicillins (P3)	No trials	1 trial (200 women)	Comparison not within scope of review	No trials	No trials	No trials	No trials
	Fluoroquinolones (F)	1 trial (81 women)	No trials	1 trial (72 women)	No trials	No trials	No trials	No trials
	Carbapenems (Ca)	No trials	1 trial (48 women)	No trials	No trials	No trials	No trials	No trials
	Macrolides (M)	1 trial (70 women)	No trials	No trials	No trials	No trials	No trials	No trials
Multiple classes administered	Broad spectrum penicillin (P2) plus antistaphylococcal penicillin (P3) plus aminoglycoside (A) plus nitroimadazole (N)	No trials	1 trial (200 women)	Comparison not within scope of review	No trials	No trials	No trials	No trials
	Antistaphylococcal penicillin (P3) plus aminoglycoside (A)	No trials	1 trial (200 women)	Comparison not within scope of review	No trials	No trials	No trials	No trials
	Natural penicillin (P1) plus nitroimidazole (N) plus macrolide (M)	No trials	No trials	Comparison not within scope of review	No trials	No trials	1 trial (241 women)	No trials
	Non‐antistaphylococcal penicillins (P1 and P2; natural and broad spectrum) plus nitroimadazole (N)	No trials	No trials	Comparison not within scope of review	No trials	2 trials (256 women)	No trials	No trials
	Non‐antistaphylococcal penicillins (P1 and P2; natural and broad spectrum) plus nitroimadazole (N) plus amphenicol (Am)	No trials	No trials	Comparison not within scope of review	No trials	No trials	No trials	1 trial (232 women)

Table 2. Comparison matrix

Ir a la tabla de la revisión

Table 3. Interventions: drugs and doses

Antistaphylococcal cephalosporins (1^st and 2^nd generation) vs broad spectrum penicillins plus betalactamase inhibitors (8 trials, 1 540 women)
Antistaphylococcal cephalosporins (1^st and 2^nd generation)			vs	Broad spectrum penicillins plus betalactamase inhibitors
Drug	Dose	Number of women		Drug	Dose	Number of women
Cefazolin	1 g single dose	289		Ampicillin plus sulbactam	1 g single dose	87
Cefazolin	2 g single dose	67			1.5 g single dose	128
Cefotetan	1 g single dose	224			3 g single dose	192
Cefotetan	2 g single dose	96		Co‐amoxyclav (amoxicillin plus clavulanic acid)	1.2 g single dose	188
Cefoxitin	2 g x 3 doses	68		Co‐amoxyclav (amoxicillin plus clavulanic acid)	2.4 g single dose	55
Cefuroxime	1.5 g single dose	85		Ticarcillin plus clavulanic acid	(3 g + 100 mg) x 3 doses	61
Antistaphylococcal cephalosporins (1^st and 2^nd generation) vs non‐antistaphylococcal penicillins (natural and broad spectrum) (9 trials, 3 093 women)
Antistaphylococcal cephalosporins (1^st and 2^nd generation)			vs	Non‐antistaphylococcal penicillins (natural and broad spectrum)
Drug	Dose	Number of women		Drug	Dose	Number of women
Cefazolin	1 g single dose	283		Ampicillin	2 g single dose	315
	2 g single dose	161		Ampicillin	1 g x 3 doses	113
	1 g x 3 doses	261		Benzathine penicillin; and Procaine penicillin	(1 200 000 IU and 400 000 IU) x 5 doses	200
Cefonicid	1 g	147		Mezlocillin	4 g single dose	51
Cefotetan	2 g, single dose	244		Mezlocillin	2 g x 3 doses	51
Cefoxitin	1 g single dose	155		Piperacillin	4 g single dose	155
	2 g single dose	162		Piperacillin	2 g x 3 doses	268
	2 g x 3 doses	278
	4 g x 3 doses	49
Cephalothin	2 g single dose	200
Minimally antistaphylococcal cephalosporins (3^rd generation) vs broad spectrum penicillins plus betalactamase inhibitors (2 trials, 865 women)
Minimally antistaphylococcal cephalosporins (3^rd generation)			vs	Broad spectrum penicillins plus betalactamase inhibitors
Drug	Dose	Number of women		Drug	Dose	Number of women
Cefotaxime	1 g single dose	431		Co‐amoxyclav (amoxicillin plus clavulanic acid)	1.2 g single dose	434
Minimally antistaphylococcal cephalosporins (3^rd generation) vs non‐antistaphylococcal penicillins (natural and broad spectrum) (4 trials, 854 women)
Minimally antistaphylococcal cephalosporins (3^rd generation)			vs	Non‐antistaphylococcal penicillins (natural and broad spectrum)
Drug	Dose	Number of women		Drug	Dose	Number of women
Cefotaxime	1 g x 3	55		Ampicillin	2 g	148
Ceftizoxime	1 g	135			1 g x 3	59
Ceftriaxone	1 g	145			1 g x 1; then 500mg x 4	125
				Mezlocillin	2 g	32
				Piperacillin	4 g	155

Table 3. Interventions: drugs and doses

Ir a la tabla de la revisión

Comparison 1. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Maternal sepsis Show forest plot	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]

1.2 Maternal endometritis Show forest plot	7	1161	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.76, 1.60]

1.3 Maternal fever (febrile morbidity) Show forest plot	3	678	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.65, 1.75]

1.4 Maternal wound infection Show forest plot	4	543	Risk Ratio (M‐H, Fixed, 95% CI)	0.78 [0.32, 1.90]

1.5 Maternal urinary tract infection Show forest plot	4	496	Risk Ratio (M‐H, Random, 95% CI)	0.64 [0.11, 3.73]

1.6 Maternal composite adverse effects Show forest plot	2	468	Risk Ratio (M‐H, Fixed, 95% CI)	0.96 [0.09, 10.50]

1.7 Maternal allergic reactions Show forest plot	2	373	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

1.8 Maternal skin rash Show forest plot	3	591	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.28, 4.11]

Comparison 1. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes

Ir a la tabla de la revisión

Comparison 2. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Maternal sepsis Show forest plot	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]

2.1.1 Elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
2.1.2 Non‐elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
2.1.3 Mixed type CS, or not defined	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]
2.2 Maternal endometritis Show forest plot	7	1161	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.76, 1.60]

2.2.1 Elective CS	1	122	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.05, 12.83]
2.2.2 Non‐elective CS	1	292	Risk Ratio (M‐H, Fixed, 95% CI)	1.72 [0.77, 3.84]
2.2.3 Mixed type CS, or not defined	5	747	Risk Ratio (M‐H, Fixed, 95% CI)	0.94 [0.61, 1.44]

Comparison 2. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS

Ir a la tabla de la revisión

Comparison 3. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by generation of cephalosporin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Maternal sepsis Show forest plot	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]

3.1.1 Cephalosporins C1 (1st generation) vs penicillins plus betalactamase inhibitors P2+	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
3.1.2 Cephalosporins C2 (2nd generation) vs penicillins plus betalactamase inhibitors P2+	1	75	Risk Ratio (M‐H, Fixed, 95% CI)	2.37 [0.10, 56.41]
3.2 Maternal endometritis Show forest plot	7	1161	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.76, 1.60]

3.2.1 Cephalosporins C1 (1st generation) vs penicillins plus betalactamase inhibitors P2+	2	268	Risk Ratio (M‐H, Fixed, 95% CI)	1.56 [0.59, 4.16]
3.2.2 Cephalosporins C2 (2nd generation) vs penicillins plus betalactamase inhibitors P2+	6	893	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.68, 1.53]

Comparison 3. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by generation of cephalosporin

Ir a la tabla de la revisión

Comparison 4. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
4.1 Maternal endometritis Show forest plot	6	2147	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.49, 1.66]

4.2 Sensitivity analysis (Fixed effects) Maternal endometritis Show forest plot	6	2147	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.86, 1.56]

4.3 Maternal fever (febrile morbidity) Show forest plot	5	798	Risk Ratio (M‐H, Random, 95% CI)	0.74 [0.39, 1.41]

4.4 Subgroup analysis by type of cephalosporin Maternal fever (febrile morbidity) Show forest plot	5	798	Risk Ratio (M‐H, Random, 95% CI)	0.74 [0.39, 1.41]

4.4.1 Cephalosporins C1 vs non‐antistaphylococcal penicillins P1 and P2	3	364	Risk Ratio (M‐H, Random, 95% CI)	0.47 [0.23, 0.97]
4.4.2 Cephalosporins C2 vs non‐antistaphylococcal penicillins P1 and P2	2	434	Risk Ratio (M‐H, Random, 95% CI)	1.24 [0.75, 2.05]
4.5 Maternal wound infection Show forest plot	5	915	Risk Ratio (M‐H, Fixed, 95% CI)	1.15 [0.59, 2.26]

4.6 Maternal urinary tract infection Show forest plot	4	515	Risk Ratio (M‐H, Random, 95% CI)	1.36 [0.59, 3.14]

4.7 Maternal composite adverse effects Show forest plot	2	1698	Risk Ratio (M‐H, Fixed, 95% CI)	2.02 [0.18, 21.96]

4.8 Maternal allergic reactions Show forest plot	2	329	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

4.9 Maternal length of hospital stay (days) Show forest plot	1	132	Mean Difference (IV, Fixed, 95% CI)	‐1.50 [‐2.46, ‐0.54]

Comparison 4. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes

Ir a la tabla de la revisión

Comparison 5. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
5.1 Maternal endometritis Show forest plot	6	2147	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.49, 1.66]

5.1.1 Elective CS	0	0	Risk Ratio (M‐H, Random, 95% CI)	Not estimable
5.1.2 Non‐elective CS	4	1818	Risk Ratio (M‐H, Random, 95% CI)	1.36 [0.99, 1.89]
5.1.3 Mixed type CS, or not defined	2	329	Risk Ratio (M‐H, Random, 95% CI)	0.31 [0.04, 2.21]

Comparison 5. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS

Ir a la tabla de la revisión

Comparison 6. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by generation of cephalosporin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
6.1 Maternal endometritis Show forest plot	6		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

6.1.1 1st generation cephalosporins (C1) vs natural and broad spectrum penicillins (P1 and P2)	4	1036	Risk Ratio (M‐H, Random, 95% CI)	0.87 [0.33, 2.34]
6.1.2 2nd generation cephalosporins (C2) vs natural and broad spectrum penicillins (P1 and P2)	3	1111	Risk Ratio (M‐H, Random, 95% CI)	1.13 [0.72, 1.77]

Comparison 6. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by generation of cephalosporin

Ir a la tabla de la revisión

Comparison 7. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
7.1 Maternal endometritis Show forest plot	6	2147	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.49, 1.66]

7.1.1 1st and 2ndgeneration cephalosporins (C1 and C2) vs natural penicillins (P1)	0	0	Risk Ratio (M‐H, Random, 95% CI)	Not estimable
7.1.2 1st and 2ndgeneration cephalosporins (C1 and C2) vs broad spectrum penicillins (P2)	6	2147	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.49, 1.66]

Comparison 7. Antistaphylococcal cephalosporins C1 and C2 (1st and 2nd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin

Ir a la tabla de la revisión

Comparison 8. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
8.1 Maternal sepsis Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

8.2 Maternal endometritis Show forest plot	2	562	Risk Ratio (M‐H, Fixed, 95% CI)	1.74 [1.10, 2.75]

8.3 Maternal fever (febrile morbidity) Show forest plot	1	114	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.29, 2.76]

8.4 Maternal wound infection Show forest plot	3	406	Risk Ratio (M‐H, Fixed, 95% CI)	0.41 [0.13, 1.28]

8.5 Maternal urinary tract infection Show forest plot	2	173	Risk Ratio (M‐H, Fixed, 95% CI)	0.54 [0.05, 5.75]

8.6 Maternal composite serious infectious complication Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

8.7 Maternal composite adverse effects Show forest plot	2	507	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

8.8 Maternal allergic reactions Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

8.9 Maternal nausea Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

8.10 Maternal vomiting Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

8.11 Maternal diarrhoea Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

8.12 Maternal skin rash Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

Comparison 8. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ all outcomes

Ir a la tabla de la revisión

Comparison 9. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
9.1 Maternal sepsis Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

9.1.1 Elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
9.1.2 Non‐elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
9.1.3 Mixed type CS, or not defined	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
9.2 Maternal endometritis Show forest plot	2	562	Risk Ratio (M‐H, Fixed, 95% CI)	1.74 [1.10, 2.75]

9.2.1 Elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
9.2.2 Non‐elective CS	2	562	Risk Ratio (M‐H, Fixed, 95% CI)	1.74 [1.10, 2.75]
9.2.3 Mixed type CS, or not defined	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

Comparison 9. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of CS

Ir a la tabla de la revisión

Comparison 10. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
10.1 Maternal sepsis Show forest plot	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

10.1.1 Cephalosporins C3 (3rd generation) vs penicillins P1 (natural)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
10.1.2 Cephalosporins C3 (3rd generation) vs penicillins P2 (broad spectrum)	1	59	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
10.2 Maternal endometritis Show forest plot	2	562	Risk Ratio (M‐H, Fixed, 95% CI)	1.74 [1.10, 2.75]

10.2.1 Cephalosporins C3 (3rd generation) vs penicillins P1 (natural)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
10.2.2 Cephalosporins C3 (3rd generation) vs penicillins P2 (broad spectrum)	2	562	Risk Ratio (M‐H, Fixed, 95% CI)	1.74 [1.10, 2.75]

Comparison 10. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) ‐ subgrouped by type of penicillin

Ir a la tabla de la revisión

Comparison 11. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
11.1 Maternal endometritis Show forest plot	2	865	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.07, 15.88]

11.2 Maternal fever (febrile morbidity) Show forest plot	1	746	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.63, 2.22]

11.3 Maternal wound infection Show forest plot	2	865	Risk Ratio (M‐H, Random, 95% CI)	0.67 [0.10, 4.58]

11.4 Maternal urinary tract infection Show forest plot	2	865	Risk Ratio (M‐H, Fixed, 95% CI)	0.51 [0.05, 5.46]

11.5 Maternal composite serious infectious complication Show forest plot	1	746	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

11.6 Maternal composite adverse effects Show forest plot	2	865	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

11.7 Maternal allergic reactions Show forest plot	2	865	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

11.8 Maternal nausea Show forest plot	1	119	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

11.9 Maternal vomiting Show forest plot	1	119	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

11.10 Maternal diarrhoea Show forest plot	1	119	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

11.11 Maternal skin rash Show forest plot	1	119	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

11.12 Maternal length of hospital stay Show forest plot	1	746	Mean Difference (IV, Fixed, 95% CI)	‐0.01 [‐0.12, 0.10]

Comparison 11. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ all outcomes

Ir a la tabla de la revisión

Comparison 12. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
12.1 Maternal endometritis Show forest plot	2	865	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.07, 15.88]

12.1.1 Elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
12.1.2 Non‐elective CS	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
12.1.3 Mixed type CS, or not defined	2	865	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.07, 15.88]

Comparison 12. Minimally antistaphylococcal cephalosporins C3 (3rd generation) vs broad spectrum penicillins plus betalactamase inhibitors P2+ ‐ subgrouped by type of CS

Ir a la tabla de la revisión

Comparison 13. Other cephalosporin (only) regimens vs other penicillin (only) regimens

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
13.1 Maternal endometritis Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

13.1.1 Cephalosporins C3 (3rd generation) vs penicillins P2 and P3 (broad spectrum and antistaphyloccal)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	2.00 [0.18, 21.71]
13.2 Maternal fever (febrile morbidity) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

13.2.1 Cephalosporins C3 (3rd generation) vs penicillins P2 and P3 (broad spectrum and antistaphyloccal)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.41, 3.35]
13.3 Maternal wound infection Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

13.3.1 Cephalosporins C3 (3rd generation) vs penicillins P2 and P3 (broad spectrum and antistaphyloccal)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.50 [0.05, 5.43]
13.4 Maternal vomiting Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

13.4.1 Cephalosporins C3 (3rd generation) vs penicillins P2 and P3 (broad spectrum and antistaphyloccal)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	7.00 [0.37, 133.78]
13.5 Maternal skin rash Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

13.5.1 Cephalosporins C3 (3rd generation) vs penicillins P2 and P3 (broad spectrum and antistaphyloccal)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	3.00 [0.12, 72.77]

Comparison 13. Other cephalosporin (only) regimens vs other penicillin (only) regimens

Ir a la tabla de la revisión

Comparison 14. Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
14.1 Maternal sepsis Show forest plot	1	72	Risk Ratio (M‐H, Fixed, 95% CI)	2.55 [0.11, 60.57]

14.2 Maternal endometritis Show forest plot	1	72	Risk Ratio (M‐H, Fixed, 95% CI)	1.17 [0.68, 2.01]

14.3 Maternal wound infection Show forest plot	1	72	Risk Ratio (M‐H, Fixed, 95% CI)	4.25 [0.21, 85.51]

14.4 Maternal urinary tract infection Show forest plot	1	72	Risk Ratio (M‐H, Fixed, 95% CI)	0.09 [0.01, 1.69]

Comparison 14. Fluoroquinolones F vs broad spectrum penicillin plus betalactamase inhibitors P2+

Ir a la tabla de la revisión

Comparison 15. Fluoroquinolones F vs cephalosporins C2 (2nd generation)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
15.1 Maternal sepsis Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.07, 16.63]

15.2 Maternal endometritis Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	1.29 [0.76, 2.19]

15.3 Maternal wound infection Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	2.15 [0.20, 22.82]

15.4 Maternal urinary tract infection Show forest plot	1	81	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

Comparison 15. Fluoroquinolones F vs cephalosporins C2 (2nd generation)

Ir a la tabla de la revisión

Comparison 16. Carbapenems Ca vs cephalosporins C3 (3rd generation)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
16.1 Maternal endometritis Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	1.18 [0.08, 17.82]

16.2 Maternal fever (febrile morbidity) Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.59 [0.06, 6.09]

16.3 Maternal wound infection Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	0.39 [0.02, 9.15]

16.4 Maternal urinary tract infection Show forest plot	1	48	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

Comparison 16. Carbapenems Ca vs cephalosporins C3 (3rd generation)

Ir a la tabla de la revisión

Comparison 17. Macrolides M vs cephalosporins C1 (1st generation)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
17.1 Maternal fever (febrile morbidity) Show forest plot	1	70	Risk Ratio (M‐H, Fixed, 95% CI)	7.00 [0.37, 130.69]

Comparison 17. Macrolides M vs cephalosporins C1 (1st generation)

Ir a la tabla de la revisión

Comparison 18. Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
18.1 Maternal endometritis Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

18.1.1 Broad spectrum penicillin P2 plus antistaphylococcal penicillin P3 plus aminoglycaside A plus nitroimadazole N vs cephalosporin C3 (3rd generation)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.07 [0.55, 2.10]
18.1.2 Antistaphylococcal penicillin P3 plus aminoglycaside A vs cephalosporin C3 (3rd generation)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	17.00 [0.99, 290.62]
18.2 Maternal fever (febrile morbidity) Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

18.2.1 Broad spectrum penicillin P2 plus antistaphylococcal penicillin P3 plus aminoglycaside A plus nitroimadazole N vs cephalosporin C3 (3rd generation)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.30, 2.46]
18.2.2 Antistaphylococcal penicillin P3 plus aminoglycaside A vs cephalosporin C3 (3rd generation)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	8.00 [1.89, 33.89]
18.3 Maternal wound infection Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

18.3.1 Broad spectrum penicillin P2 plus antistaphylococcal penicillin P3 plus aminoglycaside A plus nitroimadazole N vs cephalosporin C3 (3rd generation)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.43, 3.03]
18.3.2 Antistaphylococcal penicillin P3 plus aminoglycaside A vs cephalosporin C3 (3rd generation)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
18.4 Maternal urinary tract infection Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

18.4.1 Broad spectrum penicillin P2 plus antistaphylococcal penicillin P3 plus aminoglycaside A plus nitroimadazole N vs cephalosporin C3 (3rd generation)	1	200	Risk Ratio (M‐H, Fixed, 95% CI)	1.36 [0.66, 2.82]
18.4.2 Antistaphylococcal penicillin P3 plus aminoglycaside A vs cephalosporin C3 (3rd generation)	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
18.5 Maternal length of hospital stay (days) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.5.1 Broad spectrum penicillin P2 plus antistaphylococcal penicillin P3 plus aminoglycaside A plus nitroimadazole N vs cephalosporin C3 (3rd generation)	1	200	Mean Difference (IV, Fixed, 95% CI)	‐0.11 [‐0.37, 0.15]
18.5.2 Antistaphylococcal penicillin P3 plus aminoglycaside A vs cephalosporin C3 (3rd generation)	0	0	Mean Difference (IV, Fixed, 95% CI)	Not estimable
18.6 Costs Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

18.6.1 Broad spectrum penicillin P2 plus antistaphylococcal penicillin P3 plus aminoglycaside A plus nitroimadazole N vs cephalosporin C3 (3rd generation)	1	200	Mean Difference (IV, Fixed, 95% CI)	5.98 [4.28, 7.68]
18.6.2 Antistaphylococcal penicillin P3 plus aminoglycaside A vs cephalosporin C3 (3rd generation)	0	0	Mean Difference (IV, Fixed, 95% CI)	Not estimable

Comparison 18. Other antibiotic regimens (multiple classes) vs cephalosporin (only) regimens

Ir a la tabla de la revisión

Comparison 19. Other antibiotic regimens (multiple classes) vs penicillin (only) regimens

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
19.1 Maternal endometritis Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

19.1.1 Lincosamide L plus aminoglycoside A vs natural penicillin P1	1	88	Risk Ratio (M‐H, Fixed, 95% CI)	1.46 [0.35, 6.15]
19.1.2 Cephalosporin C1 (1st generation) plus nitroimadazole vs broad spectrum penicillin P2	1	139	Risk Ratio (M‐H, Fixed, 95% CI)	2.70 [0.63, 11.55]
19.1.3 Cephalosporin C2 (2nd generation) plus nitroimadazole N vs broad spectrum penicillin plus betalactamase inhibitors P2+	1	83	Risk Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 7.77]
19.2 Maternal fever (febrile morbidity) Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

19.2.1 Lincosamide L plus aminoglycoside A vs natural penicillin P1	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
19.2.2 Cephalosporin C1 (1st generation) plus nitroimadazole N vs broad spectrum penicillin P2	1	139	Risk Ratio (M‐H, Fixed, 95% CI)	2.36 [0.84, 6.62]
19.2.3 Cephalosporin C2 (2nd generation) plus nitroimadazole N vs broad spectrum penicillin plus betalactamase inhibitors P2+	1	83	Risk Ratio (M‐H, Fixed, 95% CI)	2.93 [0.63, 13.68]
19.3 Maternal wound infection Show forest plot	3		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

19.3.1 Lincosamide L plus aminoglycoside A vs natural penicillin P1	1	88	Risk Ratio (M‐H, Fixed, 95% CI)	1.10 [0.16, 7.43]
19.3.2 Cephalosporin C1 (1st generation) plus nitroimadazole N vs broad spectrum penicillin P2	1	139	Risk Ratio (M‐H, Fixed, 95% CI)	2.02 [0.42, 9.63]
19.3.3 Cephalosporin C2 (2nd generation) plus nitroimadazole N vs broad spectrum penicillin plus betalactamase inhibitors P2+	1	83	Risk Ratio (M‐H, Fixed, 95% CI)	0.98 [0.06, 15.09]
19.4 Maternal urinary tract infection Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

19.4.1 Lincosamide L plus aminoglycoside A vs natural penicillin P1	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
19.4.2 Cephalosporin C1 (1st generation) plus nitroimadazole N vs broad spectrum penicillin P2	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
19.4.3 Cephalosporin C2 (2nd generation) plus nitroimadazole N vs broad spectrum penicillin plus betalactamase inhibitors P2+	1	83	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable

Comparison 19. Other antibiotic regimens (multiple classes) vs penicillin (only) regimens

Ir a la tabla de la revisión

Comparison 20. Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
20.1 Maternal sepsis Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

20.1.1 Aminoglycoside A plus nitroimidazole N vs natural penicillin P1 plus nitroimidazole N plus macrolide M	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	0.81 [0.29, 2.26]
20.1.2 Antistaphylococcal cephalosporin C1 and C2 (1st and 2nd generation) plus nitroimadazole N vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) plus nitroimadazole N	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.1.3 Cephalosporin C3 (3rd generation) plus nitroimadazole N vs natural penicillin P1 plus broad spectrum penicillin P2 plus nitroimadazole N plus amphenicol Am	1	232	Risk Ratio (M‐H, Fixed, 95% CI)	3.21 [0.34, 30.45]
20.2 Maternal endometritis Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

20.2.1 Aminoglycoside A plus nitroimidazole N vs natural penicillin P1 plus nitroimidazole N plus macrolide M	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.2.2 Antistaphylococcal cephalosporin C1 and C2 (1st and 2nd generation) plus nitroimadazole N vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) plus nitroimadazole N	1	156	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.2.3 Cephalosporin C3 (3rd generation) plus nitroimadazole N vs natural penicillin P1 plus broad spectrum penicillin P2 plus nitroimadazole N plus amphenicol Am	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.3 Maternal fever (febrile morbidity) Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

20.3.1 Aminoglycoside A plus nitroimidazole N vs natural penicillin P1 plus nitroimidazole N plus macrolide M	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.3.2 Antistaphylococcal cephalosporin C1 and C2 (1st and 2nd generation) plus nitroimadazole N vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) plus nitroimadazole N	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.13, 4.14]
20.3.3 Cephalosporin C3 (3rd generation) plus nitroimadazole N vs natural penicillin P1 plus broad spectrum penicillin P2 plus nitroimadazole N plus amphenicol Am	1	232	Risk Ratio (M‐H, Fixed, 95% CI)	1.22 [0.46, 3.27]
20.4 Maternal wound infection Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

20.4.1 Aminoglycoside A plus nitroimidazole N vs natural penicillin P1 plus nitroimidazole N plus macrolide M	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	3.23 [0.34, 30.64]
20.4.2 Antistaphylococcal cephalosporin C1 and C2 (1st and 2nd generation) plus nitroimadazole N vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) plus nitroimadazole N	2	256	Risk Ratio (M‐H, Fixed, 95% CI)	2.00 [0.19, 21.61]
20.4.3 Cephalosporin C3 (3rd generation) plus nitroimadazole N vs natural penicillin P1 plus broad spectrum penicillin P2 plus nitroimadazole N plus amphenicol Am	1	232	Risk Ratio (M‐H, Fixed, 95% CI)	1.29 [0.40, 4.10]
20.5 Maternal urinary tract infection Show forest plot	2		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

20.5.1 Aminoglycoside A plus nitroimidazole N vs natural penicillin P1 plus nitroimidazole N plus macrolide M	1	241	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.07, 17.03]
20.5.2 Antistaphylococcal cephalosporin C1 and C2 (1st and 2nd generation) plus nitroimadazole N vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) plus nitroimadazole N	1	156	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.5.3 Cephalosporin C3 (3rd generation) plus nitroimadazole N vs natural penicillin P1 plus broad spectrum penicillin P2 plus nitroimadazole N plus amphenicol Am	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.6 Maternal composite adverse effects Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

20.6.1 Aminoglycoside A plus nitroimidazole N vs natural penicillin P1 plus nitroimidazole N plus macrolide M	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.6.2 Antistaphylococcal cephalosporin C1 and C2 (1st and 2nd generation) plus nitroimadazole N vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) plus nitroimadazole N	1	100	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.6.3 Cephalosporin C3 (3rd generation) plus nitroimadazole N vs natural penicillin P1 plus broad spectrum penicillin P2 plus nitroimadazole N plus amphenicol Am	0	0	Risk Ratio (M‐H, Fixed, 95% CI)	Not estimable
20.7 Maternal length of hospital stay Show forest plot	2		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

20.7.1 Aminoglycoside A plus nitroimidazole N vs natural penicillin P1 plus nitroimidazole N plus macrolide M	1	241	Mean Difference (IV, Fixed, 95% CI)	‐0.30 [‐0.78, 0.18]
20.7.2 Antistaphylococcal cephalosporin C1 and C2 (1st and 2nd generation) plus nitroimadazole N vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) plus nitroimadazole N	1	100	Mean Difference (IV, Fixed, 95% CI)	‐0.53 [‐1.36, 0.30]
20.7.3 Cephalosporin C3 (3rd generation) plus nitroimadazole N vs natural penicillin P1 plus broad spectrum penicillin P2 plus nitroimadazole N plus amphenicol Am	0	0	Mean Difference (IV, Fixed, 95% CI)	Not estimable
20.8 Costs Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

20.8.1 Aminoglycoside A plus nitroimidazole N vs natural penicillin P1 plus nitroimidazole N plus macrolide M	0	0	Mean Difference (IV, Fixed, 95% CI)	Not estimable
20.8.2 Antistaphylococcal cephalosporin C1 and C2 (1st and 2nd generation) plus nitroimadazole N vs non‐antistaphylococcal penicillins P1 and P2 (natural and broad spectrum) plus nitroimadazole N	1	100	Mean Difference (IV, Fixed, 95% CI)	‐136.12 [‐165.73, ‐106.51]
20.8.3 Cephalosporin C3 (3rd generation) plus nitroimadazole N vs natural penicillin P1 plus broad spectrum penicillin P2 plus nitroimadazole N plus amphenicol Am	0	0	Mean Difference (IV, Fixed, 95% CI)	Not estimable

Comparison 20. Other antibiotic regimens (multiple classes) versus different antibiotic regimens (multiple classes)

Ir a la tabla de la revisión

Comparison 21. (Irrigation/lavage) cephalosporins vs penicillins

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
21.1 Maternal endometritis Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.1.1 Cephalosporins C2 (2nd generation) vs penicillins P2 (broad spectrum)	1	383	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.63, 1.43]
21.2 Maternal fever (febrile morbidity) Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.2.1 Cephalosporins C2 (2nd generation) vs penicillins P2 (broad spectrum)	1	383	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.63, 1.43]
21.3 Maternal wound infection Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

21.3.1 Cephalosporins C2 (2nd generation) vs penicillins P2 (broad spectrum)	1	383	Risk Ratio (M‐H, Fixed, 95% CI)	1.06 [0.27, 4.17]

Comparison 21. (Irrigation/lavage) cephalosporins vs penicillins

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet

Scolaris Content Display Scolaris Content Display

Administración sistemática de diferentes clases de antibióticos a las mujeres para la prevención de la infección en la cesárea

Información

Cifras del artículo

Altmetric:

Citado por:

Autores

Contributions of authors

Sources of support

Internal sources

External sources

Declarations of interest

Acknowledgements

Version history

Differences between protocol and review

Notes

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

PICO

PICO

Population

Intervention

Comparison

Outcome

Scolaris Language Selector Scolaris Language Selector

Scolaris Content Display Scolaris Content Display

Instituciones a las que se accedió previamente

Scolaris Content Display Scolaris Content Display

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso

	Idioma de la Revisión Cochrane Escoja su idioma de preferencia para las revisiones Cochrane y otros contenidos. Las secciones sin una traducción aparecerán en inglés.

	Idioma de la web Escoja su idioma de preferencia para la web de la Biblioteca Cochrane.

Idioma de la Revisión Cochrane

Idioma de la web

Información

Cifras del artículo

Altmetric:

Citado por:

Autores

Contributions of authors

Sources of support

Internal sources

External sources

Declarations of interest

Acknowledgements

Version history

Differences between protocol and review

Notes

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

PICO

PICO

Population

Intervention

Comparison

Outcome

Copiar o descargar referencia

Idioma de la Revisión Cochrane

Idioma de la web

Instituciones a las que se accedió previamente

Usuarios institucionales

Instituciones a las que se accedió previamente

Otras opciones de acceso