Azithromycin intake during childbirth lowers maternal infection risk, but impact on newborns uncertain

Finland: A recent systematic review and meta-analysis revealed a reduction in maternal postpartum infections, including sepsis, with the intrapartum administration of azithromycin to the mother. Azithromycin, however, did not seem to reduce neonatal sepsis or mortality rates. 

The study published in the International Journal Of Obstetrics and Gynaecology by Ilari Kuitunen and colleagues examined the effects of intrapartum azithromycin administration on maternal and neonatal infections and mortality. It provided valuable insights into the use of this antibiotic during childbirth.

The review, which included data from five randomised controlled trials involving a total of 44,190 women and 44,565 neonates, sought to determine the impact of a single intrapartum dose of azithromycin when compared to a placebo.

Here are the main findings from the study:

● Reduced Risk of Maternal Infections: Intrapartum azithromycin significantly reduced the risk of endometritis by 36% (1.5% in the azithromycin group vs. 2.3% in the placebo group). The certainty of this evidence was high.

● Chorioamnionitis Risk: The incidence of chorioamnionitis was lower in the azithromycin group (0.05%) compared to the placebo group (0.1%), though this difference did not reach statistical significance. The certainty of this evidence was moderate.

● Lower Wound Infection Rates: Women who received azithromycin during childbirth experienced a lower rate of wound infections (1.6%) compared to those in the placebo group (2.5%). The evidence for this was considered moderate.

● Reduced Maternal Sepsis: Azithromycin administration resulted in a 34% reduction in maternal sepsis risk, with rates of 1.1% in the azithromycin group and 1.7% in the placebo group. The certainty of this evidence was high.

● No Impact on Maternal or Neonatal Mortality: There was no significant difference in maternal mortality rates between the two groups (0.09% in the azithromycin group vs. 0.08% in the placebo group). Similarly, neonatal mortality rates were comparable (0.7% in the azithromycin group vs. 0.8% in the placebo group).

● Comparable Neonatal Sepsis Rates: Neonatal sepsis rates were similar between the azithromycin group (7.6%) and the placebo group (7.4%).

In conclusion, intrapartum administration of azithromycin to expectant mothers has shown promise in reducing the risk of maternal postpartum infections, including sepsis. However, its impact on maternal mortality remains uncertain. Importantly, the use of azithromycin did not lead to a reduction in neonatal sepsis or mortality rates.

These findings underscore the potential benefits of azithromycin in improving maternal health outcomes during childbirth but suggest the need for further research to clarify its

impact on neonatal outcomes. Healthcare professionals should consider these results when making clinical decisions regarding the use of azithromycin in intrapartum care.

Reference:

Kuitunen, I., Kekki, M., & Renko, M. (2023). Intrapartum azithromycin to prevent maternal and neonatal sepsis and deaths: A systematic review with meta‐analysis. BJOG: An International Journal of Obstetrics and Gynaecology. https://doi.org/10.1111/1471-0528.17655