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Prescribing Pattern and Timing of Antimicrobial Prophylaxis for Elective Caesarean Delivery at Wad Medani Obstetrics and Gynecology Teaching Hospital, Sudan (2015)

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dc.contributor.author Mohi eldin, Tahani Elfaki Abbas
dc.date.accessioned 2019-01-02T07:55:09Z
dc.date.available 2019-01-02T07:55:09Z
dc.date.issued 2017-07
dc.identifier.uri http://repo.uofg.edu.sd/handle/123456789/3296
dc.description A thesis Submitted to the University of Gezira in Fulfilment for the Requirement for the Award of the Degree of Doctor of Philosophy In Clinical Pharmacology Department of Pharmacology ,Faculty of Pharmacy July,2017 en_US
dc.description.abstract Women undergoing caesarean delivery have an increased likelihood of infection compared with those who give birth vaginally. Antibiotic prophylaxis is recommended to reduce post-caesarean delivery infections. But the regimens used are often inappropriate which may result in the appearance of drug-resistant organisms, and will increase the cost. The time of administrating prophylactic antibiotic in cesarean delivery, is a matter of controversy; as prophylactic antibiotics were administered after umbilical cord clamping due to the concern for potential transfer of antibiotics to the neonate. Recent evidence recommends the use of pre-incision, prophylactic antibiotics. Therefore this study was aimed to audit the prescribing patterns of prophylactic antibiotics for elective caesarean delivery (CD) at Medani maternity hospital and a randomized, controlled clinical trial was conducted to compare the effectiveness of antibiotic prophylaxis before skin incision with that after umbilical cord clamping in preventing infectious complications of CD and neonatal outcomes. Ceftizoxime was prescribed for 63.9 % of women. It was used alone or in combination with gentamicin and metronidazole. The second regime was cefuroxime which was used in combination with metronidazole or gentamicin and metronidazole with overall rate of 36.1%. Prophylaxis duration is 6.3 days. Antibiotic prophylaxis was given after cord clamping (91.1%). Oral cefuroxime with metronidazole was the preferred regime (77.2 %) on discharge. Three hundred women (150 women in each group) received intravenous injection of 1.5 g of Cefuroxime as single dose either at pre-incision or after clamping of the umbilical cord. None of the women in either group had endometritis. There was no significant difference in the incidence of wound infection between the two groups, 12 (8.0%) vs. 4 (2.7%); P = 0.06), two babies in the pre-incision group (P = 0.497) had low Apgar score (<8) at 1 min. 30 neonates in the pre-incision group and 26 neonates in the post incision group (P=0.657) were admitted to nursery (eight in each group) of the new born had neonatal jaundice, P = 1.000. Over use of antibiotic prophylaxis for elective CD was observed. Pre-incision and post-clamping of the umbilical cord administration of prophylactic antibiotics for elective CD are equally effective . Efforts and programs to improve antimicrobial prophylaxis are required and should aim to increase the quality of antimicrobial prophylaxis and to control the unnecessarily use of postoperative antimicrobial prophylaxis. The timing of antimicrobial prophylaxis should be prior to skin incision. Further studies may be needed to address the long- term adverse effects on neonates. en_US
dc.description.sponsorship Ishag Adam. (Main supervisor) Elhassan Mohammed Elhassan. (Co-supervisor) Imad eldinMohamod Tag eldin. (Co-supervisor) Mirgani Abdel Rahman Yousif (Co-supervisor) en_US
dc.language.iso en en_US
dc.publisher University of Gezira en_US
dc.subject caesarean delivery en_US
dc.subject birth vaginally en_US
dc.subject prophylactic antibiotics en_US
dc.title Prescribing Pattern and Timing of Antimicrobial Prophylaxis for Elective Caesarean Delivery at Wad Medani Obstetrics and Gynecology Teaching Hospital, Sudan (2015) en_US
dc.type Thesis en_US

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