WHO recommendation on routine antibiotic prophylaxis for episiotomy

illustration of episiotomy

WHO recommendation on routine antibiotic prophylaxis for episiotomy



Routine antibiotic prophylaxis is not recommended for women with episiotomy.

(Not recommended)


Publication history

First published: September 2015

Updated: No update planned

Assessed as up-to-date: September 2015



  • This recommendation has been integrated from the WHO recommendations for prevention and treatment of maternal peripartum infections, in which the GDG for that guideline determined it to be a conditional recommendation based on GDG consensus. (WHO recommendation against routine antibiotic prophylaxis for women with episiotomy)
  • This recommendation was based on a consensus of the GDG in view of a high rate of episiotomy and the potential impact of antibiotics, in the absence of clinical benefits for public health. The GDG places emphasis on avoidance of emerging antimicrobial resistance at the global level and, therefore, made a strong recommendation.  
  • This recommendation applies to the use of antibiotics before or immediately after episiotomy repair following vaginal birth. Antibiotics should only be administered when there are clinical signs of infection of an episiotomy wound.
  • The GDG emphasized the need for health systems to adopt a policy of restrictive rather than routine use of episiotomy to reduce its potential complications and the use of additional resources for its treatment.  
  • Second-degree perineal tear is anatomically similar to an episiotomy and does not warrant the use of prophylactic antibiotics.  
  • In a situation where an episiotomy wound extends to become a third- or fourth-degree perineal tear, prophylactic antibiotics should be administered: WHO recommendation on routine antibiotic prophylaxis for women with third- or fourth-degree perineal tear
  • The evidence supporting this recommendation can be found in the source guideline document, available at:




​​Related links

WHO recommendations on intrapartum care for a positive childbirth experience

(2018) - full document and evidence tables

Managing Complications in Pregnancy and Childbirth: A guide for midwives and doctors

Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for essential practice

WHO Programmes: Sexual and Reproductive health

Maternal Health


Citation: WHO Reproductive Health Library. WHO recommendation on routine antibiotic prophylaxis for episiotomy (February 2018). The WHO Reproductive Health Library; Geneva: World Health Organization.