Efficacy and safety of broad spectrum penicillins with or without beta-lactamase inhibitors versus 1st and 2nd generation cephalosporins as prophylactic antibiotics at cesarean section: a systematic review and meta-analysis

Purpose To assess the efficacy and safety between broad spectrum penicillins with or without beta-lactamase inhibitors versus 1st and 2nd generation cephalosporins in prevention of post-caesarean infections.Methods Randomized controlled trials (RCTs) comparing broad spectrum penicillins with or without beta-lactamase inhibitors to 1st and 2nd generation cephalosporins were searched in foreign databases, such as the Cochrane Library, PubMed and EMBASE, and chinese databases, including the China National Knowledge Infrastructure (CNKI) WanFang Data and China Science and Technology Journal Database(CSTJ). The included RCTs were analyzed by the software Rev Man 5.4.Results A total of nine RCTs, 1998 patients were involved. Six trials compared broad spectrum penicillins plus beta-lactamase inhibitors versus 1st and 2nd generation cephalosporins, we found there were no differences between interventions for endometritis(RR 0.85, 95% CI 0.57–1.26, I2 = 0.0%), wound infection(RR 1.28, 95% CI 0.53–3.12, I2 = 0.0%), urinary tract infection(RR 1.70, 95% CI 0.06–47.34, I2 = 79%), febrile morbidity(RR 0.95, 95% CI 0.32–2.84, 1 study), maternal rashes(RR 1.20, 95% CI 0.26–5.58, I2 = 0.0%). Four trials compared broad spectrum penicillins versus 1st and 2nd generation cephalosporins, we found there were no differences between interventions for endometritis(RR 3.22, 95% CI 0.45–22.89, I2 = 64%), febrile morbidity(RR 1.93, 95% CI 0.48–7.83, I2 = 84%), wound infection(RR 1.19, 95% CI 0.20–6.97, I2 = 70%), urinary tract infection(RR 9.00, 95% CI 0.49–163.90, 1 study). The postoperative length of stay was longer for women in the broad spectrum penicillins group than 1st generation cephalosporins group(MD 1.50, 95% CI 0.54–2.46, 1 study). Conclusion Based on the results of this study, broad spectrum penicillins with or without beta-lactamase inhibitors and 1st and 2nd generation cephalosporins may have similar efficacy at caesarean section regarding postoperative infections. PROSPERO Registration Number: CRD42022345721.