Does azithromycin have a role in cesarean sections?
Yes, adding azithromycin to the usual antibiotic protocol in nonelective c-sections reduces infections. But not everyone can take advantage of it.
PRACTICE CHANGER
Prescribe a one-time dose of azithromycin 500 mg intravenously, along with standard antibiotic prophylaxis, at the time of cesarean delivery to prevent postoperative infections.1
STRENGTH OF RECOMMENDATION
B: Based on a single good-quality, randomized controlled trial.
Tita AT, Szychowski JM, Boggess K, et al. Adjunctive azithromycin prophylaxis for cesarean delivery. N Engl J Med. 2016;375:1231-1241.
WHAT’S NEW
Azithromycin reduces infections without increasing adverse events
This study showed that adding azithromycin to standard antibiotic prophylaxis within one hour of a c-section reduces post-cesarean delivery infection rates without increasing the risk of maternal or neonatal adverse events.
CAVEATS
Proceed with caution in those with prolonged QT intervals
While azithromycin was efficacious and well tolerated in the study, not every patient can take it. Patients with a previous drug reaction or allergy should avoid it, and experts advise prescribing it with caution for patients who have (or are at increased risk for) a prolonged QT interval, including those on other QT-prolonging medications.
Of note, women with scheduled c-sections and those with chorioamnionitis or another infection requiring postpartum antibiotics were excluded from this study. Thus, it is unknown if azithromycin use decreases complications in these patients.
CHALLENGES TO IMPLEMENTATION
Speed of procedure is often paramount, so drug availability is key
Nonelective c-sections occur based on many factors that include a non-reassuring fetal heart rate. In many of these cases, speed of cesarean delivery may mean the difference between positive and negative outcomes. Availability of azithromycin on labor and delivery floors for timely administration within one hour of the procedure is important.
Additionally, azithromycin has known QT prolongation risks.11 While the baseline QT interval is not known for many healthy, young women, this should be considered when azithromycin is utilized in combination with other medications that may prolong the QT interval.
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
