Surgical antibiotic prophylaxis in women undergoing caesarean delivery: a systematic review of clinical practice guidelines

Background: Clinical practice guidelines (CPGs) are essential in hospitals to guide the use of surgical antibiotic prophylaxis for women delivering via caesarean section (c-section). Although CPGs exist, the quality of these documents is infrequently examined. Objective: The purpose of this systematic review is to examine the quality of CPGs directing the use of antibiotic prophylaxis in c-sections and review the evidence informing current recommendations. Search strategy: We systematically searched Medline, EMBASE and LILACS for publications which included recommendations for surgical antibiotic prophylaxis in caesarean deliveries published between 2015 and 2025. Google Scholar, databases of organisations and reference lists of included studies were also searched. Selection criteria: Two reviewers independently screened the titles and abstracts of the retrieved publications. Two reviewers independently screened articles identified for full-text review. Data collection and analysis: Data were independently collected by two reviewers using a standardised data collection tool. Discrepancies were resolved via discussion. Main results: Eleven guidelines from several geographical regions were included in the review. Pre-incision cefazolin was explicitly recommended by 45% of guidelines. When appraised using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool, the methodological quality of guidelines varied substantially for four of the examined domains. Stakeholder involvement had a median score of 54% (range: 7–96), rigour of development 43% (4–97), applicability 14% (0–88) and editorial independence 58% (0–100). Information relevant to guideline development was not accessible for some CPGs. Conclusion: CPG development should be a rigorous process, with all information about development made easily accessible for the users and recipients of the practice recommendations. Registration: https://osf.io/vqgpm.