Extended-Spectrum Antibiotic Prophylaxis at Cesarean Delivery

Summary and Comment |
September 28, 2016

Extended-Spectrum Antibiotic Prophylaxis at Cesarean Delivery

  1. Allison Bryant, MD, MPH

Adding azithromycin to standard antibiotic prophylaxis was associated with lower risk for postoperative infection.

  1. Allison Bryant, MD, MPH

Complications of cesarean delivery such as endometritis and wound infection lead to significant maternal morbidity and use of health care resources. Given the high annual number of cesareans in the U.S., interventions to lower the postoperative infection rate would have significant impact. Investigators conducted a 14-center randomized trial to determine the effect of adding a single 500-mg intravenous dose of azithromycin (active against ureaplasma and other pathogens) to the standard cefazolin-based perioperative antibiotic regimen for cesareans performed during labor or after membrane rupture.

Of the 1019 women who received adjunctive prophylactic azithromycin, 6.1% had diagnoses of postoperative infection within 6 weeks of delivery compared with 12.0% of the 994 women who received placebo; specifically, risks for endometritis and wound infection were lower in the azithromycin group. Neonatal outcomes through the first 3 months did not differ between groups.


These results show that broadening antibiotic coverage for nonelective cesarean delivery can result in a clinically meaningful decrease in maternal infectious morbidity without compromising early neonatal health. Particularly for institutions with high rates of surgical-site infections and patients who have significant comorbidities that raise their infection risk, adopting such a protocol is likely to improve maternal outcomes. Close surveillance for unintended consequences, whether locally (e.g., increases in neonatal “septic work-ups”) or broadly (e.g., changes to the infant microbiome with longer-term health effects), will be critical in determining the overall success of this effort to diminish infectious complications of cesarean delivery.

Editor Disclosures at Time of Publication

  • Disclosures for Allison Bryant, MD, MPH at time of publication Nothing to disclose


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