A Randomized controlled trial comparing the efficacy of a seven day regimen of co-amoxiclav versus a single dose second generation cephalosporin (cefoxitin) as prophylactic antibiotic therapy for third and fourth degree perineal lacerations among post-partum patients in a tertiary medical center / Samantha Quennie Wanasen-Razon; Lylah D. Reyes; Jennifer Co.

Includes appendices and bibliographical references.

Abstract: Episiotomy is a common obstetrical practice in the Philippines. However, particularly from midline episiotomy, a third- or fourth degree extension may not be prevented. This predisposes the episiotomy site to infection and wound breakdown due to bacterial contamination from the rectum. Compare the efficacy of single dose cefoxitin versus seven-day regimen of Co-amoxiclav in preventing wound infection of third- or fourth degree perineal tears among women who had episiotomy during vaginal delivery. Included were 64 women, 18 to 35 years old, who delivered vaginally and sustained a third or fourth degree laceration during episiotomy. Participants were randomly allocated to group A: single dose of Cefoxitin, 1 gram intravenous, given 30 minutes after delivery and group B: Co-amoxiclav, 750 mg twice a day for seven days postdelivery. Assessment for wound infection, pain/discomfort and adverse event rates as well as mean pain, REEDA scores and length of hospital stay between two groups were done right after episiorrphy, on the day of discharge and seven days after discharge. Wound infection, pain and discomfort were not noted for both treatment arms during the seven-day follow up period. The mean pain and REEDA scores tend to be higher among the participants in the co-amoxiclav group. There was also more adverse effects, such as nausea, dizziness and vomiting noted among those participants in the co-amoxiclav than in the cefoxitin group. Length of hospital stay ranged from 2 to 4 days with a mean of 2.98. Although, no statistically significant differences were noted between the two groups. Seven-day oral co-amoxiclav is comparable with single dose intravenous cefoxitin in preventing wound infection from third- or fourth degree perineal tears as well as safety. Thereby, compared to oral co-amoxiclav regimen, single dose cefoxitin is the cost-beneficial option among women with episiotomies having extension.

Research - Department of Obstetrics & Gynecology