Drawbacks of antibiotic regimen following cesarean deliveries on beneficial bacteria in colostrum, a prospective observational study

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BACKGROUND: The dramatic increase in Cesarean Section (CS) deliveries raises significant concerns due to risks such as unnecessary surgery, elevated healthcare costs, antibiotic overuse, and disruption of maternal breast milk microflora, which impacts infant gut microbiota. OBJECTIVE AND METHODS: This study evaluates optimal antibiotic regimens for CS to preserve Lactobacilli and Bifidobacteria while ensuring aseptic wound conditions, thereby addressing antibiotic misuse and resistance. A cohort of 116 mothers received prophylactic antibiotics (third-generation Cephalosporins, Penicillin/β-lactam, or Linezolid) administered preoperatively and continued orally for 1, 3, or 5 days. Inclusion criteria comprised women with BMI 18-29 kg/m² undergoing elective CS for obstetric indications (malpresentation, placenta previa, recurrent CS). Colostrum samples were microbiologically analyzed using nutrient agar, De Man, Rogosa and Sharpe (MRS) agar, and Bile salt L-cysteine MRS (BL-MRS) agar to quantify total bacteria, Lactobacilli, and Bifidobacteria. RESULTS: Cephalosporins caused the most substantial microbial reduction: 60.18% by day 5 and 59.2% by day 3. Linezolid for 5 days followed (48.7% reduction), while Penicillin/β-lactam for 3 and 5 days resulted in 33.93% and 36.9% reductions, respectively. Cephalosporins and Linezolid significantly reduced Bifidobacteria on days 3 and 5 (P < 0.05). Linezolid exhibited the most potent inhibition against Lactobacilli. CONCLUSION: No significant differences in wound healing outcomes were observed among antibiotic regimens (P = 0.916). Preoperative prophylaxis with Penicillin/β-lactam is recommended, as it minimally disrupts Lactobacilli and Bifidobacteria while maintaining aseptic conditions, offering a balanced approach to microbial preservation and infection prevention.

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