In Reply

Letter to the Editor Perioperative Antibiotic Prophylaxis Indications and Modalities for the Prevention of Postoperative Wound Infection by Prof. Dr. med. Christian Eckmann, PD Dr. med. Seven Johannes Sam Aghdassi, Prof. Dr. med. Alexander Brinkmann, Prof. Dr. med. Mathias Pletz, PD Dr. med. Jessica Rademacher in issue 7/2024

We thank our colleagues for their comments. They address a specific situation within perioperative antibiotic prophylaxis (PAP)—namely, the benefit and potential harm of antibiotic administration for the mother and baby in the context of a cesarean section. The benefit of PAP in this setting is well documented for the mother; a Cochrane review analyzed the benefit of PAP during cesarean section on the basis of 95 randomized controlled trials (1). Preoperative antibiotic prophylaxis resulted in a reduction of episodes of fever, endometritis, wound infection, urinary tract infection, and severe infections. For this reason, PAP during cesarean section has an evidence based recommendation in the 2020 S3 guideline (2). Nevertheless, the harm of administering antibiotics for the baby’s microbiome must be considered. This requires careful evaluation. The substances most commonly used in studies for PAP in cesarean section are first generation or second generation cephalosporins (cefazolin or cefuroxime). According to a 2020 review article, these substances have a negligible potential for affecting the microbiome negatively (3). This is particularly the case if the modalities of PAP are correctly adhered to and they are administered once only. Administration of amoxicillin with or without clavulanic acid, by contrast, can lead to notable alterations of the microbiome and should therefore be avoided (3). These facts should be described and agreed with patients when giving PAP before an elective cesarean section. This is an integral component of modern individualized antibiotic prophylaxis, which we described in our article (4).

DOI: 10.3238/arztebl.m2024.0118

On behalf of the authors

Prof. Dr. med. Christian Eckmann

Klinik für Allgemein-, Viszeral- und Thoraxchirurgie und ABS-Team

Klinikum Hannoversch Münden

Hannoversch Münden

Conflict of interest statement

CE is head of the working group on general and visceral surgical infection of the German Society for General and Visceral Surgery and received an honorarium for a podcast from Infectopharm.

References

1. Smaill FM, Grivell RM: Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2014; 28: CD007482

2. Louwen F, Wagner U, Abou-Dakn M, et al.: Caesarean Section. Guideline of the DGGG, OEGGG und SGGG (S3-Level, AWMF Registry No. 015/084, June 2020). Geburtshilfe Frauenheilk 2021; 81: 896–921

3. Elvers KT, Wilson VJ, Hammond A, et al.: Antibiotic-induced changes in the human gut microbiota for the most commonly prescribed antibiotics in primary care in the UK: a systematic review. BMJ Open 2020; 10: e035677

4. Eckmann C, Aghdassi SJS, Brinkmann A, Pletz M, Rademacher J: Perioperative antibiotic prophylaxis—indications and modalities for the prevention of postoperative wound infection. Dtsch Arztebl Int 2024; 121: 233–42