may have contributed to these infections, the reader is left with the unmistakable impression that this outbreak resulted from a failure of cefotetan as a prophylactic agent. No mention is made of other factors that may have contributed, however, including timing of prophylaxis, use of postoperative drains, commonality of operating room personnel, method and timing of skin preparation, etc. No microbiological data are presented to support the notion that cefotetan-resistant organisms lead to this outbreak. In this era of cost consciousness, I believe it is unfortunate that such hypotheses are published without additional scientific support. In fact, there is no evidence that any second or third generation cephalosporin is superior to first generation cephalosporins in prophylaxis for cesarean section. A recent issue of the Medical Letter on Drugs and Therapeutics2 advocates the use of a single dose of cefazolin for prophylaxis in high-risk cesarean sections. The three prospective studies3-5 cited by Dougherty and Williams also fail to indicate any superiority of one agent over another, whether that agent be cefoxitin, cefotetan or cefazolin. In any institution, small transient increases in infection rates are inevitable. In our experience, the mere recognition of the epidemic usually heralds its disap-