Azithromycin Prophylaxis to Reduce Infection Risk Post C-Section
This NICHD study by Tita et al (NEJM, 2016) aimed to determine if prophylactic treatment with azithromycin before a non-elective C-section (laboring or ruptured membranes) reduces the rate of postoperative infection.
Randomized Controlled Trial (RCT)
2013 women with singleton pregnancies at ≥24 week’s gestation received antibiotic prophylaxis; 1,019 received 500mg IV azithromycin and 994 received a placebo. Primary outcomes included endometritis, wound infection, or other infection occurring within six weeks. Primary outcomes occurred in 62 (6.1%) women in the treatment group, and 119 (12%) in the placebo group (P<0.001). In addition, rates of endometritis were 3.8% in the treatment group and 6.1% in the placebo group (P=0.02), wound infection rates were 2.4% in the treatment group and 6.6% in the placebo group (P<0.001), and rate of serious maternal adverse events were 1.5% in the treatment group and 2.9% in the placebo group (P=0.03). There were no additional differences in composite newborn outcomes. The authors conclude that adjunctive azithromycin for cesarean delivery in women at increased risk for infection is safe, reduces infection rates does not increase risk to newborns.
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