Meta-analysis: Postoperative oral antibiotics reduce cellulitis after cesarean in obese women

This meta-analysis aimed to evaluate the effectiveness of adding postoperative oral cephalexin and metronidazole to standard preoperative prophylaxis in preventing surgical site infections (SSI) among obese women undergoing cesarean delivery. We systematically searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for randomized controlled trials. Studies involving obese women undergoing cesarean delivery with the intervention of postoperative oral cephalexin plus metronidazole were included. Data were analyzed using a random-effects model to pool risk ratios (RRs) with 95% confidence intervals (CIs). Three randomized controlled trials, encompassing 1144 patients, were included. The pooled analysis revealed that postoperative oral cephalexin and metronidazole significantly reduced the incidence of cellulitis (RR 0.50; 95% CI 0.28-0.89; p = 0.01). However, no statistically significant differences were found for other outcomes, including wound separation (RR 0.68; 95% CI 0.40-1.14), fever (RR 0.49; 95% CI 0.08-3.01), composite SSI (RR 0.55; 95% CI 0.29-1.05), endometritis (RR 0.49; 95% CI 0.13-1.94), or wound seroma (RR 0.9; 95% CI 0.51-1.57). Sensitivity analysis indicated the significance for cellulitis was sensitive to individual studies. In conclusion, the addition of postoperative oral cephalexin and metronidazole reduces cellulitis incidence in obese women following cesarean section. While a broader impact on other surgical site infections was not observed, this targeted benefit for cellulitis suggests a potential role as an adjunct to current prophylaxis. Further robust research is needed to validate these findings and refine preventive strategies.