Cefazolin for Cesarean Delivery

First-Line Antibiotic Recommendation

Cefazolin is the antibiotic of choice for prophylaxis in cesarean delivery according to multiple high-quality guidelines 1, 3
The American College of Obstetricians and Gynecologists recommends administration of cefazolin 30-60 minutes before skin incision to maximize effectiveness in preventing surgical site infections 2
The recommended dosing is 2g IV initial dose, then 1g IV every 8 hours until delivery 4

The American Society of Health-Systems Pharmacists, Infectious Diseases Society of America, Surgical Infection Society, and Society for Healthcare Epidemiology of America all recommend cefazolin as the first-choice antibiotic for surgical prophylaxis in most procedures, including cesarean delivery 3
The Society of Obstetricians and Gynecologists of Canada specifically recommends a single dose first-generation cephalosporin (such as cefazolin) for all women undergoing cesarean section 3
Cefazolin is superior to clindamycin for surgical prophylaxis due to its narrow spectrum of activity and ability to achieve high intraamniotic concentrations 6

For patients with non-severe penicillin allergy (no history of anaphylaxis, angioedema, respiratory distress, or urticaria), cefazolin remains the preferred agent 5, 6
For patients with severe penicillin allergy (high risk for anaphylaxis), clindamycin 900 mg IV every 8 hours is recommended 4, 5
If GBS isolates are resistant to clindamycin or susceptibility is unknown, vancomycin 1g IV every 12 hours should be used 4, 5

Routine use of vancomycin is not recommended for standard prophylaxis and should be reserved for specific situations such as known MRSA colonization or severe penicillin allergy 3
Antibiotic prophylaxis is not recommended for cesarean deliveries performed before labor onset on women with intact amniotic membranes, regardless of GBS colonization status 8
Broader spectrum agents might be necessary for treatment of chorioamnionitis rather than simple prophylaxis 4