Add on azithromycin before cesarean section can improve postoperative outcomes and reduce NICU admissions: Study

Antibiotic prophylaxis has been a standard practice to prevent SSIs in cesarean deliveries. Traditionally, first-generation cephalosporins have been the recommended prophylactic agents. However, recent research has explored the potential benefits of adding azithromycin, a macrolide antibiotic, to the standard prophylactic regimen. The effectiveness of this prophylactic has been attributed to its ability to provide coverage against Ureaplasma species, often linked to infections after cesarean delivery. In September 2018, the American College of Obstetricians and Gynecologists (ACOG) approved the inclusion of azithromycin in the standard antibiotic treatment for non-elective C-sections.

Emergency cesarean deliveries, with their higher risk of post-operative infection compared to vaginal deliveries, underscore the need for impactful research. Standard care involves administering prophylactic antibiotics like cefazolin before surgery, but post-cesarean infections like wound infection, endometritis, and urinary tract infections persist. Azithromycin, a broad-spectrum macrolide antibiotic, has shown efficacy in reducing infectious complications when combined with standard prophylactic antibiotic regimens. A randomised controlled trial is needed to evaluate the safety and efficacy of adding a single dose of azithromycin, with the potential to impact post-cesarean infection rates significantly. Hence, authors undertook this study to assess whether adding azithromycin to standard antibiotic prophylaxis before skin incision would reduce the incidence of surgical site infection after cesarean section.

In this randomized prospective observational study, 520 pregnant women at ≥28 weeks gestation underwent emergency cesarean section at B.M. Patil Medical College and Research Centre, Vijayapura. They were split into two groups: Group A received azithromycin and standard cephalosporin prophylaxis, while Group B received only ceftriaxone. Exclusion criteria and medical assessments were conducted, and Group A received intravenous azithromycin before the procedure. Post-operative monitoring continued for six weeks, and statistical analysis was performed using JMP-SAS Software.

Group A had lower postoperative complication rates than Group B. Group A had 1.5% abnormal cases on the 7th-day follow-up versus 4.6% in Group B (p=0.041). By the 14th day, Group A had 1.14% abnormal cases compared to 3.8% in Group B (p=0.023). Group A also showed lower rates of induration (18.6% vs 29.9%), erythema (10.6% vs 20.3%), NICU admission (7.98% vs 14.2%), and secondary suturing (1.14% vs 3.8%). The mean hospital stay was slightly shorter in Group A (7.67 days vs 7.75 days) but not statistically significant (p=0.477).

Adding azithromycin to standard antibiotic prophylaxis for emergency cesarean sections significantly improved postoperative outcomes, reducing complications and NICU admissions. This study contributes to growing evidence supporting expanded antibiotic prophylaxis in cesarean deliveries. While promising, the implementation should consider local guidelines and patient-specific factors. Further research is needed to validate these findings and assess their broader applicability across diverse populations and healthcare settings.