The recommendation in this document thus supersedes the previous WHO recommendation on prophylactic antibiotics for women undergoing caesarean section as published in the 2015 guideline WHO recommendations for prevention and treatment of maternal peripartum infections.
The primary audience for this recommendation includes health professionals who are responsible for developing national and local health-care guidelines and protocols (particularly those related to the prevention and treatment of peripartum infections) and those involved in the provision of care to women and their newborns during labour and childbirth, including midwives, nurses, general medical practitioners and obstetricians, as well as managers of maternal and child health programmes, and relevant staff in ministries of health and training institutions, in all settings.
Summary of clarifying remarks:
- For antibiotic prophylaxis for caesarean section, a single dose of first-generation cephalosporin or penicillin should be used in preference to other classes of antibiotics. This antibiotic choice is based on 1) effectiveness, and 2) as part of efforts to contain antimicrobial resistance.
- However, the choice of an antibiotic should be adapted to the local context: informed by local antimicrobial resistance guidance, local bacteriologic patterns of post-caesarean infectious morbidity, safety profile, the clinician’s experience with that particular class of antibiotics, availability and cost.
- Prophylactic antibiotics are recommended for women undergoing elective or emergency caesarean section and should be given 30–60 minutes prior to skin incision, rather than intraoperatively after umbilical cord clamping.
- Emphasizes the importance of using a simple and short (single dose, 30–60 minutes before surgery) antibiotic regimen for prophylaxis, unless there are other clinical factors for consideration (e.g. high maternal body mass index, prolonged labour, prolonged duration of surgery, extensive surgical manipulation or massive blood loss) that might increase the risk of developing post-caesarean infections. Clinical judgement is needed to evaluate if a different regimen (e.g., higher dose, second dose) of prophylactic antibiotics is warranted in the presence of risk factors.