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The Cochrane Review entitled "Antibiotic prophylaxis for caesarean section" analysed a large number of randomized controlled trials. It found that the use of antibiotic prophylaxis in women undergoing caesarean section leads to a decreased risk of infection-related complications, including fever, endometritis, wound infection, urinary tract infection, and serious infection after caesarean section; a small reduction was also found in the mother's duration of stay in hospital. There was, however, an increased risk of certain side-effects, although they were neither serious nor consistently recorded. Regardless of the antibiotic regimen used and of the differences among populations studied, the protective effect of prophylactic antibiotics was homogeneous across all patients undergoing caesarean section (reported in the trials as being elective, non-elective, or not specified). This effect of significant reduction in postoperative infectious morbidity (by around two-thirds) leads the reviewers to recommend that antibiotic prophylaxis be provided to all woman undergoing caesarean section.

The second review entitled "Antibiotic prophylaxis regimens and drugs for caesarean section" aimed to identify the most effective antibiotic regimen for the specific purpose of decreasing infectious morbidity after caesarean section. It found that it does not matter which regimen is used. Ampicillin and first generation cephalosporins show similar effectiveness and there seems to be no justification for using any other drug with a broader spectrum or multiple drugs. These effects are similar and homogeneous for all the main outcomes measured: endometritis, febrile morbidity, wound infections and urinary tract infection. There was, however, no consensus on the optimal timing of administration and doses.

Randomized controlled trials indexed in the Cochrane Pregnancy and Childbirth Group and the Cochrane Controlled Trials Register were selected for inclusion in both the reviews. The data were then pooled and analysed following standard procedures.

As to analysis of subgroups of data, a concern may arise regarding "non-elective caesarean section". In the trials this term was applied to women in labour with or without rupture of membranes for more than six hours. It would perhaps have been interesting to have these two conditions evaluated separately. This suggestion is based on the assumption that the effect of antibiotic prophylaxis would be higher among women with prelabour rupture of membranes for more than six hours.

The full RHL commentary also includes sections on: