Antibiotics for Epidural-Related Fever in Labor?

Alex Macario, MD, MBA


March 21, 2014

A Randomized Trial of the Effects of Antibiotic Prophylaxis on Epidural-Related Fever in Labor

Sharma SK, Rogers BB, Alexander JM, McIntire DD, Leveno KJ
Anesth Analg. 2014;118:604-610

Study Summary

This is a double-blind study of 400 healthy nulliparous women requesting epidural analgesia at Parkland Hospital at the University of Texas Southwestern Medical Center. The participants were randomly assigned to receive either cefoxitin 2 g or placebo right before an epidural catheter was placed for labor analgesia (median duration, approximately 6 hours). This trial found that 38% of women administered cefoxitin developed fever, defined as a maternal temperature of ≥ 38°C, which did not differ statistically from the 40% incidence of fever in the placebo group.

Neutrophilic infiltration of the placenta and membranes was found in approximately 50% of both study groups. Although fever developed significantly more often in women with placental neutrophilic inflammation than in those without this condition, no difference was detected in placental neutrophilic inflammation between the antibiotic group and the placebo group. The investigators also found no differences in any neonatal outcomes, and sepsis was not diagnosed in any infant. The conclusion of the study is that infection is unlikely to be the cause of fever during labor epidural analgesia.


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