Antibiotic Azithromycin Reduces C-section Infection by Half

Highlights:

The rates of Cesarean delivery are on the rise
One in 10 women is at risk of C-section scar infection
Expectant mothers who undergo C-section are often given a standard antibiotic regimen to reduce infection
Administration of an antibiotic azithromycin plus a standard antibiotic regimen during Cesarean delivery can lower rate of post-delivery infections by 50%

Pregnant women who go for a Cesarean delivery or C-section are given a standard antibiotic regimen, cefazolin to reduce the risk of infection. Physicians at the University of Alabama found that women given the antibiotic azithromycin alongside the standard antibiotic regimen had a lower rate of post-delivery infections than women who received placebo plus standard prophylaxis in a randomized trial.

Cesarean delivery is the most common major surgical procedure. Women who had C-section are five times at risk for infection than women who had a vaginal delivery. C-section infection is one of the top five causes of maternal death in the United States. Infections increase the rates of readmissions, emergency room visits, and clinic visits.

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‘Compared to women who received cefazolin (standard antibiotic prophylaxis), women who received both cefazolin and azithromycin were 50% less likely to develop infections.’

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Dr Alan T. N. Tita, the professor in the UAB Division of Maternal-Fetal Medicine and the Center for Women’s Reproductive Health, said, “Infection during pregnancy and during the post-pregnancy period is a major health problem for both mom and baby and a common underlying cause of death.”

Dr. Alan T. N. Tita

Antibiotic Azithromycin Reduces Risk of C-section Incision Infection and Endometritis

A randomized clinical trial was conducted across 14 hospitals in the United States. The trial included 2,013 women who were more than 24 weeks’ gestation and undergoing a C-section during labor or after membrane rupture.

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The study participants were randomly divided into two groups. One group received the standard antibiotic regimen to prevent infection. The other group received a modified regimen with the additional antibiotic azithromycin. The data gathered from the 14 hospitals were analyzed by the UAB Department of Biostatistics. The results showed that the rates of endometritis (infection of the lining of the uterus) and infection of the cesarean incision reduced by 50% in women who received azithromycin and cefazolin, compared to women who received only the standard single antibiotic. Babies born to women who received additional azithromycin did not have an increased risk of adverse events. The researchers also found that the rates of hospital readmission, unscheduled clinic visit, and visit to the emergency room were reduced in the group that received azithromycin.

“When our group first developed the idea that a second antibiotic could help reduce infections for these women, we found reassurance in the fact that some patients who have preterm premature rupture of the membranes receive two antibiotics to help reduce infection and prolong pregnancy,” said Tita.

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“There are significant costs associated with infections. The reduction in the rates of readmissions, visits, fevers and overall antibiotic use due to the intervention was higher than we expected, and translates to reduced health care costs,” he added.

Jeff Szychowski, Ph.D., associate professor in the UAB School of Public Health Department of Biostatistics, said, “The benefits associated with the additional antibiotic azithromycin are consistent across several subgroups of patients. Thanks to the dedication of research staff across the consortium of 14 centers to successfully execute a clinical trial of this magnitude, we are poised to perform multiple follow-up investigations and to understand the ramifications of these results more completely.”

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“This was a significant breakthrough that has identified a simple and inexpensive way to reduce the most common complication associated with cesarean delivery,” said Dr William Andrews, chair of the UAB Department of OB/GYN and chair of the Steering Committee for the study.

Dr Uma Reddy, the NICHD project officer for the study, said, “These results are crucial, given that the maternal death rate has increased in the US and there is an urgent need for therapies to decrease serious complications that can lead to maternal deaths.”

The trial was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The antibiotic azithromycin was donated by Pfizer. The study is published in the New England Journal of Medicine.

Cesarean Delivery

C-section is a surgical procedure to deliver a baby. The baby is taken out through an incision in the mother's abdomen. A C-section is planned when the pregnant woman develops complications. About 3 to 6 percent of women who have undergone a C-section are vulnerable to infections. C-section infection can occur due to lack of hygiene. Obese and overweight women are at high risk of getting C-section wound infected. Women who had pregnancy complications such as gestational diabetes, high blood pressure, and autoimmune disease are also at high risk for infection.

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