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    How azithromycin prophylaxis before cesarean can reduce postop infection

    A multicenter study funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and published in the New England Journal of Medicine may indicate that the addition of azithromycin prophylaxis before cesarean delivery could prevent postoperative infection.

    The study was conducted in 14 centers across the United States. The researchers looked at 2013 women who had a singleton pregnancy with gestation lasting 24 weeks or more and were undergoing cesarean delivery during labor or after membrane rupture. They assigned 1019 of the women to received 500 mg intravenous azithromycin and 994 to receive placebo. Each woman was scheduled to receive the standard antibiotic prophylaxis. Primary outcome was a composite of wound infection, endometritis, or other infection occurring within 6 weeks.

    Primary outcome occurred in 62 women (6.1%) who had received azithromycin and in 119 (12.0%) who had received the placebo (relative risk, 0.51; 95% confidence interval [CI], 0.38 to 0.68; P<0.001). Significant differences were observed between the azithromycin group and the placebo group in rates of endometritis (3.8% vs 6.1%, P=0.02), wound infection (2.4% vs 6.6%, P<0.001), and serious maternal adverse events (1.5% vs 2.9%, P=0.03). When looking at secondary neonatal composite outcomes, such as neonatal death or serious neonatal complications, no significant between-group differences were seen (14.3% vs 13.6%, P=0.63).

    Next: Postpartum infection leads to amputation

    The researchers concluded that adjunctive azithromycin along with standard antibiotic prophylaxis were more effective than placebo in reducing the risk of postoperative infection.

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.


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