***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In an ongoing prospect i ve study at 2 hospitals , 114 cesarean section patients were studied to determine whether giving ampicillin after umbilical cord clamping is as effective as perioperative ampicillin in reducing maternal postoperative morbidity . The same patients have also been studied to determine the effect of prophylactic cesarean section ampicillin on the newborn . Results have shown that prophylactic ampicillin initiated after cord clamping is as effective in reducing maternal morbidity as ampicillin initiated prior to the surgery . There is also no evidence from our study that the transplacental passage of prophylactic ampicillin increases immediate or delayed neonatal infections A prospect i ve r and omized clinical trial was conducted to test the effectiveness of long-term and short-term prophylaxis with cefuroxime in preventing morbidity after cesarean section .  Sixty patients who required emergency cesarean section were r and omly assigned to one of three treatment groups : a control group of 20 patients receiving no prophylactic antibiotics ; a group of 20 patients receiving 24 hours of cefuroxime prophylaxis ( 0.75 gm 30 to 60 minutes before surgery and at 8 hours and 16 hours after surgery ) ; and a group of 20 patients receiving five days of cefuroxime prophylaxis ( 0.75 gm three times a day , the first dose being given postoperatively ) . The short-term and long-term prophylaxes were equally effective in reducing morbidity , assessed by postoperative temperatures , presence or absence of endometritis , and duration of postoperative hospital stay The effectiveness of a single prophylactic dose of two broad spectrum antibiotics , during Caesarean section , was compared and evaluated . In 119 consecutive cases at the Cantonal Hospital in Winterthur , Switzerl and , either 1 g i.v . cefotaxime or 1,2 g amoxicillin plus clavulanic acid were administered after clamping the umbilical cord during Caesarean section . The study shows that single dose prophylaxis of either regimen provides adequate cover in preventing morbidity in Caesarean section , in both high-risk and low-risk groups In a prospect i ve , r and omized trial , the efficacy of a single-dose , first-generation , long-acting cephalosporin was compared with a three-dose regimen in a group of 100 women undergoing cesarean section who were at high risk for postoperative febrile morbidity . Fifty women received a single 1 gm intravenous dose of cefazolin and 50 received 1 gm of the drug followed by two additional doses , 8 hours apart , to complete a three-dose regimen . Another 50 women , considered to be at low risk for postoperative febrile morbidity , were not given antibiotic prophylaxis . Outcomes of febrile morbidity ( 18 % vs 12 % ) and particularly morbidity caused by endometritis ( 6 % vs 8 % , respectively ) were similar for single-dose and three-dose groups . In the untreated low-risk group there were no cases of endometritis and the febrile morbidity was comparable to that of the prophylactically treated groups ( 14 % vs 15 % ) . Single-dose cefazolin prophylaxis appears to be comparable to multidose prophylaxis in reducing febrile morbidity after cesarean section The use of antibiotics for prophylaxis against infection among women undergoing nonelective cesarean section has become the st and ard of care in the United States . Many different antibiotics have been used successfully . Single-dose regimens administered after the cord is clamped have proven just as effective as multiple-dose regimens . Although the most frequently used class of antibiotics is the cephalosporin family , the single best agent has not been determined . This study was a double-blind , r and omized trial in which we compared a narrow-spectrum cephalosporin ( cefazolin ; n = 63 ) with an exp and ed-spectrum cephamycin ( cefoxitin ; n = 66 ) and with a broad-spectrum cephalosporin ( cefotaxime ; n = 60 ) used as a single-dose prophylaxis in patients undergoing a nonelective cesarean section . Of the 194 patients enrolled in the study , 189 were evaluable . There was no significant difference between the groups in mean age , gravidity , parity , duration of labor , duration of ruptured membranes , number of vaginal examinations , or socioeconomic status ( socioeconomic status was defined by third-party coverage ) . There was no significant difference among the antibiotics in the incidence of immediate or delayed postoperative infections . These data indicate that a less expensive , narrow-spectrum cephalosporin is as effective as more expensive , broader-spectrum cephamycins and cephalosporins as prophylaxis for patients undergoing nonelective cesarean section This study compared the efficacy of a single intravenous dose of Cefazolin alone or combined with an antibiotic containing preclosure-irrigation solution in patients undergoing cesarean section . A total of 308 patients were prospect ively assigned to two groups by r and omization . Group I received two grams of Cefazolin IV and abdomino-peritoneal irrigation with saline . Group II received one gram of Cefazolin IV and one gram in the saline irrigation solution . The rate of total postoperative morbidity was 2.3 times higher in Group I compared to Group II ( 16/154 or 10.4 % vs 7/154 or 4.5 % ) and morbidity at the operative site was six times higher ( 13/154 or 8.4 % vs 2/154 or 1.3 % ) A r and omized , prospect i ve , double-blind study was design ed to compare intravenous administration with intrauterine irrigation using an extended half-life ( tl/2=three hours ) cephalosporin , ceforanide .  Patients included in the study had a nonelective cesarean section with rupture of membranes for three hours or longer . Sixty-four patients received a single dose of ceforanide immediately after clamping the umbilical cord . Patients were similar in both groups in age , weight , length of labor , and duration of ruptured membranes . The group receiving the intravenous ceforanide had a significantly shorter duration of surgery than the patients receiving the intrauterine ceforanide .  Endometritis infection rates were similar , 11.8 % ( intravenous ) versus 11.1 % ( intrauterine ) , P>.1 . Serum levels were as much as tenfold higher in the intravenous group versus the intrauterine group . Intrauterine irrigation with an antimicrobial agent provided no advantage over systemic administration A prospect i ve and r and omized study was undertaken to determine the safety and efficacy of low price and discouraging bacterial resistance agents , given for 12 hours versus 72 hours , as prophylaxis at cesarean section . Ninety six patients received penicillin ( ten million units ) intravenously and tetracycline ( 0.25 g ) intramuscularly at cord clamping and 12 hours postoperatively ( table I ) . Among them 14 % of febrile morbidity was recorded ( table II ) . Eighty seven patients received the same treatment followed by oral ampicillin ( 2 g ) and tetracycline ( 1.5 g ) per day , for a further 60 hours ( table I ) . Maternal febrile morbidity was not further reduced by the oral additional treatment ( table II ) . This regiment prophylactic effect is comparable to previous reported data concerning other protocol s , and even better , while expenses are reduced and efficacy for important pathogens such as chlamydia and mycoplasma is obtained . No side effects of the drugs were recorded To study the effectiveness of anaerobic coverage in prevention of postpartum endometritis in women undergoing nonelective cesarean sections , we conducted a r and omized prospect i ve double-blind study of women undergoing cesarean sections and requiring antibiotic prophylaxis from April 1 , 1989 , through December 31 , 1990 . Ninety-four patients were enrolled in the study . Forty-five patients received ampicillin alone  and 46 received ampicillin in conjunction with sulbactam . All patients were evaluated prior to surgery and in the postoperative period . Ninety-one patients completed the study and their records were analyzed . Patients were divided into two groups depending on the presence or absence of ruptured membranes . Seventy-five percent of patients had ruptured membranes . Failure of prophylaxis and subsequent endometritis was documented in 8.8 % of patients who received ampicillin and sulbactam and 35.3 % of patients who received ampicillin alone . This difference was statistically significant ( p < 0.02 ) . In conclusion , single-dose ampicillin and sulbactam provides better prophylaxis than single-dose ampicillin in women undergoing cesarean section with rupture of membranes A prospect i ve r and omized study was undertaken in 100 patients undergoing cesarean section to evaluate the efficacy of cefotaxime when given as a single-dose versus the more traditional triple-dose regimen for prophylaxis . Analysis of the results demonstrated no significant differences in febrile morbidity ( 14 versus 20 % ) or postoperative endometritis ( 10 versus 14 % between the single- and triple-dose groups , respectively . Pretherapy aerobic and anaerobic placental cultures were positive in 60 % of the overall study population . In those patients who subsequently developed endometritis , seven ( 58 % ) had a positive placental culture , suggesting that this technique is relatively nonspecific as a screening procedure . Results of transcervical culture in the endometritis patients most often demonstrated a polymicrobial picture . Several of the organisms cultured were found to be resistant to cefotaxime , supporting the need to better guide antimicrobial therapy by routine endometrial culturing in patients who fail prophylaxis . The results of the present study suggest that single-dose administration of cefotaxime is equally effective as triple-dose therapy in reducing postcesarean section endometritis The purpose of this prospect i ve investigation was to compare a single intravenous dose of cefazolin to a single dose of cefonicid as prophylaxis for women having unscheduled cesarean delivery . In a double-blind , r and omized design , 96 patients were assigned to receive a 1-g dose of cefazolin  and 103 patients were design ated to receive a 1-g dose of cefonicid . The antibiotics were administered after delivery of the infant . The two groups were comparable with respect to recognized risk factors for postcesarean infection . There were no statistically significant differences between the groups in the incidence of st and ard febrile morbidity , endomyometritis , urinary tract infection , wound infection , and bacteremia . There were also no significant differences between the groups in the fever index or the duration of hospitalization . We conclude that cefazolin and cefonicid provide a similar degree of prophylaxis against infection in patients having unscheduled cesarean delivery This study included 207 patients in a double-blind , prospect i ve r and omized trial of cefazolin veisus cefam and ole single-dose prophylaxis by both intravenous ( IV ) and lavage routes in patients laboring with ruptured membranes who eventually had nonelective cesareans . No significant differences ( P < .05 ) were noted in the rates of infectious morbidity  ( cefazolin IV : six of 47 , 13 % ; cefazolin lavage : nine of 59 , 15 % ; cefam and ole IV : six of 47 , 13 % ; cefam and ole lavage : six of 54 , 11 % ) . The incidence of operative complications in the patients developing endometritis ( eight of 22 , 36 % ) was significantly different ( P < .004 ) from that in the group who did not develop endometritis ( 21 of 185 , 11 % ) . Cefazolin by IV and lavage routes of administration appears to be as effective as cefam and ole by either route of administration A study comparing the efficacy of cefotetan versus cefoxitin for prophylaxis in patients undergoing cesarean section was carried out at the University of Iowa . After institutional review , 36 subjects who met the study criteria and agreed to participate were entered into the study ; of these , 29 were evaluable for efficacy . Twenty subjects received a single 2 gm dose of cefotetan , and nine subjects received three 2 gm doses each of cefoxitin . Both antibiotics were administered intravenously at the time the umbilical cord was clamped . The subsequent doses of cefoxitin were given intravenously at four and eight hours after the initial dose . Clinical and bacteriologic responses were evaluated ; there were no statistically significant differences between the two groups , and both antibiotics provided effective prophylaxis against infection . It appears that cefotetan is a satisfactory antibiotic choice for cesarean section prophylaxis . Further , in this small study it appears that a single dose of cefotetan is as effective as three doses of cefoxitin . This implies that cefotetan would not only decrease administration time and supplies but would decrease the cost to the patient while maintaining very acceptable infection rates Despite the increasing popularity of antibiotic prophylaxis to reduce febrile morbidity in patients who undergo cesarean delivery , little is known of the pharmacokinetics of antibiotics in the patient at term gestation . This study was design ed to eluci date 
    Output:
    
REVIEW ER 'S CONCLUSIONS Both ampicillin and first generation cephalosporins have similar efficacy in reducing postoperative endometritis .
There does not appear to be added benefit in utilizing a more broad spectrum agent or a multiple dose regimen .