Azithromycin Prophylaxis for Cesarean Delivery

Posted by • September 29th, 2016

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Cesarean delivery is the most common major surgical procedure and is associated with a rate of surgical-site infection (including endometritis and wound infection) that is 5 to 10 times the rate for vaginal delivery. Tita et al. assessed whether the addition of azithromycin to standard antibiotic prophylaxis before skin incision would reduce the incidence of infection after cesarean section among women who were undergoing nonelective cesarean delivery during labor or after membrane rupture. In this new Original Article involving women who received standard antibiotic prophylaxis for nonelective cesarean section, the risk of infection after surgery was lower with the addition of azithromycin than with placebo.

Clinical Pearl

• How does pregnancy-associated infection rank as a cause of maternal death in the United States?

Globally, pregnancy-associated infection is a major cause of maternal death and is the fourth most common cause in the United States.

Clinical Pearl

• How often do postoperative infections occur after nonelective cesarean delivery?

Despite routine use of antibiotic prophylaxis (commonly, a cephalosporin given before skin incision), infection after cesarean section remains an important concern, particularly among women who undergo nonelective procedures (i.e., unscheduled cesarean section during labor, after membrane rupture, or for maternal or fetal emergencies). As many as 60 to 70% of all cesarean deliveries are nonelective; postoperative infections occur in up to 12% of women undergoing nonelective cesarean delivery with standard preincision prophylaxis.

Morning Report Questions

Q: Does the addition of azithromycin to standard antibiotic prophylaxis reduce the frequency of infection after nonelective cesarean section?

A: In the study by Tita et al., the authors found that the addition of azithromycin to standard antibiotic prophylaxis significantly reduced the frequency of infection after nonelective cesarean section. The primary outcome was a composite of endometritis, wound infection, or other infections (abdominopelvic abscess, maternal sepsis, pelvic septic thrombophlebitis, pyelonephritis, pneumonia, or meningitis) occurring up to 6 weeks after surgery. The primary composite outcome occurred in 62 women (6.1%) who received azithromycin and in 119 (12.0%) who received placebo (relative risk, 0.51; 95% confidence interval [CI], 0.38 to 0.68; P<0.001). The use of azithromycin was associated with significantly lower rates of endometritis (3.8% vs. 6.1%; relative risk, 0.62; 95% CI, 0.42 to 0.92; P=0.02) and wound infections (2.4% vs. 6.6%; relative risk, 0.35; 95% CI, 0.22 to 0.56; P<0.001). The risks of other infections were low and did not differ significantly between groups.

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Q: Does the addition of azithromycin to standard antibiotic prophylaxis for nonelective cesarean delivery increase the risk of serious neonatal complications? 

A: In the study by Tita et al., there was no significant between-group difference in a secondary neonatal composite outcome that included neonatal death and serious neonatal complications (14.3% vs. 13.6%, P=0.63).

One Response to “Azithromycin Prophylaxis for Cesarean Delivery”

  1. Satish krishnan says:

    Interesting. What is good that it’s a cheap antibiotic which would help in the developing nations .