Can Clarithromycin Be Used as Antibiotic Prophylaxis for Cesarean When Azithromycin is Unavailable?
BACKGROUND AND PURPOSE:
There have been reported shortages of azithromycin due to the COVID-19 pandemic | Azithromycin can be considered for adjunct use in women undergoing cesarean section in addition to standard prophylaxis (usually cefazolin)
Martingano et al (PLoS ONE, 2020) evaluated safety and effectiveness of clarithromycin as an adjunct prophylactic alternative for patients undergoing non-elective cesarean delivery
Multi-center, prospective observational cohort study
Women undergoing non-elective cesarean deliveries
Clarithromycin for adjunct surgical prophylaxis
No macrolide antibiotic
Development of postpartum endometritis
Meconium-stained amniotic fluid at time of cesarean delivery
Neonatal acute respiratory distress syndrome
Clarithromycin: 133 patients
No macrolide prophylaxis: 107 patients
Patients who received clarithromycin had significantly lower rates of postpartum endometritis (P=0.025)
No macrolide prophylaxis: 11.2%
In unadjusted analysis, there was a significantly lower risk for developing endometritis in the clarithromycin group (P=0.040)
66% decreased risk (95% CI, 0.12 to 0.95)
Adjusted analysis: Risk for endometritis in the clarithromycin group was still significantly lower (P=0.034)
67% decreased risk (95% CI, 0.11 to 0.97)
In stratified analysis, there was a significantly decreased risk of endometritis with clarithromycin in
Crude: 87% decreased risk (95% CI, 0.08 to 0.83; P=0.032)
Adjusted: 91% decreased risk (95% CI, 0.06 to 0.79; P=0.026)
Women 18 to 29 years
Crude: 79% decreased risk (95% CI, 0.06 to 0.80; P=0.014)
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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