Administering Additional Antibiotic Prior to C-Section Reduces Infection Rates by Half

BIRMINGHAM, Ala -- September 28, 2016 -- Administering the antibiotic azithromycin alongside the standard recommended antibiotic regimen, cefazolin, reduces infection rates by 50% for women who have a non-elective caesarean section (C-section) delivery, according to a study published in the New England Journal of Medicine (NEJM).

Adding azithromycin 500 mg during a C-section also significantly decreased the use of healthcare resources, including readmissions, emergency room visits, and clinic visits.

“Infection during pregnancy and during the postpregnancy period is a major health problem for both mom and baby, and a common underlying cause of death,” said Alan T. N. Tita, MD, Center for Women’s Reproductive Health, University of Alabama at Birmingham (UAB), Birmingham, Alabama. “Women who have a C-section are at significantly increased risk for infection compared with those who deliver vaginally. A major national goal is to reduce the risk of infection after surgery, and this finding is the culmination of investigative work over decades.”

“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 2 antibiotics to help reduce infection and prolong pregnancy,” he explained.

The current study was conducted across 14 hospitals in the United States with 2,013 women who were more than 24 weeks’ gestation and undergoing a C-section during labour or after membrane rupture. A randomized group of patients received either the standard antibiotic regimen to prevent infection or a modified regimen with the additional azithromycin.

“These results are extremely important, given that the maternal death rate has increased in the United States and there is an urgent need for therapies to decrease serious complications that can lead to maternal deaths,” said Uma Reddy, MD, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of the National Institutes of Health (NIH), Bethesda, Maryland.

The UAB Department of Biostatistics analysed data gathered from 14 participating hospitals to reveal that the frequency of endometritis. Infection of the caesarean wound was decreased by 50% in the women who received the adjunctive azithromycin compared with women who received the standard single antibiotic.

The babies who were delivered with the additional azithromycin did not have an increased risk of adverse events.

“Further analyses indicate that the benefits associated with adjunctive azithromycin are consistent across several subgroups of patients,” said Jeff Szychowski, PhD, UAB School of Public Health Department f Biostatistics. “Thanks to the dedication of research staff across the consortium of 14 centres 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.”

Hospital readmission rates and unscheduled visits to a clinic or to the emergency room were also reduced.

“There are significant costs associated with infections,” said Dr. Tita. “The reduction in readmissions, visits, fevers and overall antibiotic use due to the intervention was higher than we expected, and translates to reduced healthcare costs.”

SOURCE: University of Alabama at Birmingham