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Cochrane Database of Systematic Reviews

Profilaxis habitual con antibióticos después del parto vaginal normal para la reducción de la morbilidad infecciosa materna

Información

DOI:
https://doi.org/10.1002/14651858.CD012137.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 13 noviembre 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Embarazo y parto

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Mercedes Bonet

    Correspondencia a: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

    [email protected]

  • Erika Ota

    Global Health Nursing, St. Luke's International University, Graduate School of Nursing Sciences, Tokyo, Japan

  • Chioma E Chibueze

    Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan

  • Olufemi T Oladapo

    UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

Contributions of authors

All review authors were involved in development of the protocol.
M Bonet and CE Chibueze assessed relevant trials, extracted, entered and checked data from trials into RevMan.
M Bonet and CE Chibueze interpreted the data and drafted the review.
All authors read and approved the final version of the review for publication.

Sources of support

Internal sources

  • The Grant of National Center for Child Health and Development, 27B‐10, 26A‐5, Japan.

External sources

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

  • Japan Agency for Medical Research and Development, Japan.

    The National Research Center for Child Health and Development, Japan receives government funding (AMED No.27300101) from the Clinical Research Program for Child Health and Development, AMED, Japan to support the Cochrane Pregnancy and Childbirth Satellite in Japan.

Declarations of interest

Mercedes Bonet: none known.
Erika Ota: none known.
Chioma E Chibueze's work was financially supported by the The Grant of National Center for Child Health and Development, Japan 27B‐10, 26A‐5.
Olufemi T Oladapo: none known.

Acknowledgements

As part of the prepublication editorial process, this review has been commented on by four peers (an editor and three referees who are external to the editorial team) and the Group's Statistical Adviser.

This work was supported by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research (RHR), World Health Organization.

Chioma E Chibueze's work was financially supported by the The Grant of National Center for Child Health and Development, Japan 27B‐10, 26A‐5.

The World Health Organization and Erika Ota and Chioma E Chibueze retain copyright and all other rights in their respective contributions to the manuscript of this review as submitted for publication.

This project was supported by the National Institute for Health Research, 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 Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2017 Nov 13

Routine antibiotic prophylaxis after normal vaginal birth for reducing maternal infectious morbidity

Review

Mercedes Bonet, Erika Ota, Chioma E Chibueze, Olufemi T Oladapo

https://doi.org/10.1002/14651858.CD012137.pub2

2016 May 07

Routine antibiotic prophylaxis after normal vaginal birth for reducing maternal infectious morbidity

Protocol

Mercedes Bonet, Erika Ota, Chioma E Chibueze, Olufemi T Oladapo

https://doi.org/10.1002/14651858.CD012137

Differences between protocol and review

The name of the outcome 'puerperal infection' was revised to endometritis.
There are no further differences between the published protocol (Bonet 2016) and this full review.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Female; Humans; 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.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 1 Endometritis.
Figuras y tablas -
Analysis 1.1

Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 1 Endometritis.

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Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 2 Urinary tract infection.
Figuras y tablas -
Analysis 1.2

Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 2 Urinary tract infection.

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Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 3 Wound infection (episiotomy dehiscence).
Figuras y tablas -
Analysis 1.3

Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 3 Wound infection (episiotomy dehiscence).

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Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 4 Adverse effects of antibiotics (skin rash).
Figuras y tablas -
Analysis 1.4

Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 4 Adverse effects of antibiotics (skin rash).

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Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 5 Length of maternal hospital stay ‐ days.
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Analysis 1.5

Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 5 Length of maternal hospital stay ‐ days.

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Study

Experimental

Control

Fernandez 1993

3600 USD

9000 USD

Figuras y tablas -
Analysis 1.6

Comparison 1 1. Antibiotic prophylaxis versus no treatment/placebo, Outcome 6 Cost of care (cost of antibiotic prophylaxis, prolonged hospitalisation and treatment of endometritis).

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Summary of findings for the main comparison. Routine antibiotic prophylaxis compared to no treatment or placebo for preventing infections in women who had normal vaginal births

Routine antibiotic prophylaxis compared to no treatment/placebo for preventing infections in women who had normal vaginal births

Patient or population: Women who had normal vaginal births
Setting: Healthcare facilities in Brazil, France and the USA.
Intervention: Routine antibiotic prophylaxis (amoxicillin/clavulanic, chloramphenicol, sulphamethoxypyridazine)
Comparison: Placebo or no treatment

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no treatment/placebo

Risk with routine antibiotic prophylaxis

Incidence of severe maternal infectious morbidity (including septicaemia, septic shock, laparotomy/hysterectomy for infection, maternal intensive care unit admission, or organ failure)

not estimable

not estimable

not estimable

0
(0 RCT)

‐

No trial reported this outcome

Endometritis

Study population

RR 0.28
(0.09 to 0.83)

1364
(2 RCTs)

⊕⊝⊝⊝
VERY LOW 1, 2

‐

23 per 1000

7 per 1000
(2 to 20)

Urinary tract infection

Study population

RR 0.25
(0.05 to 1.19)

1706
(2 RCTs)

⊕⊕⊝⊝
LOW 1

‐

32 per 1000

8 per 1000
(4 to 18)

Wound infection (episiotomy dehiscence)

Study population

RR 0.78
(0.31 to 1.96)

1364
(2 RCTs)

⊕⊝⊝⊝
VERY LOW 1, 5

‐

7 per 1000

10 per 1000
(3 to 32)

Adverse effects of antibiotics (skin rash)

Study population

RR 3.03
(0.32 to 28.95)

1706
(2 RCTs)

⊕⊝⊝⊝
VERY LOW 1, 3

‐

0 per 1000

0 per 1000
(0 to 0)

Length of maternal hospital stay

The mean length of maternal hospital stay (including maternal re‐admission to hospital) was 5.12 days

MD 0.15 lower
(0.31 lower to 0.01 higher)

not estimable

1291
(1 RCT)

⊕⊝⊝⊝
VERY LOW 4, 5

‐

Individual antimicrobial resistance

not estimable

not estimable

not estimable

0
(0 RCT)

‐

No trial reported this outcome

*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 quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: 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 quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1Two studies with very serious design limitations (‐2).
2Few events (‐1).
3Few events, wide confidence interval crossing the line of no effect (‐1).
4One study with very serious design limitations (‐2).
5Wide confidence interval crossing the line of no effect (‐1).

Figuras y tablas -
Summary of findings for the main comparison. Routine antibiotic prophylaxis compared to no treatment or placebo for preventing infections in women who had normal vaginal births
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Comparison 1. 1. Antibiotic prophylaxis versus no treatment/placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Endometritis Show forest plot

2

1364

Risk Ratio (M‐H, Fixed, 95% CI)

0.28 [0.09, 0.83]

2 Urinary tract infection Show forest plot

2

1706

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.05, 1.19]

2.1 Short‐duration prophylaxis

1

1291

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.18, 1.45]

2.2 Long‐duration prophylaxis

1

415

Risk Ratio (M‐H, Random, 95% CI)

0.11 [0.03, 0.46]

3 Wound infection (episiotomy dehiscence) Show forest plot

2

1364

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.31, 1.96]

4 Adverse effects of antibiotics (skin rash) Show forest plot

2

1706

Risk Ratio (M‐H, Fixed, 95% CI)

3.03 [0.32, 28.95]

5 Length of maternal hospital stay ‐ days Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

6 Cost of care (cost of antibiotic prophylaxis, prolonged hospitalisation and treatment of endometritis) Show forest plot

Other data

No numeric data
Figuras y tablas -
Comparison 1. 1. Antibiotic prophylaxis versus no treatment/placebo
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