Peripartum usage of azithromycin prophylaxis to prevent sepsis in women who delivered with vaginal birth
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by An Duc Thien Le |
Posted on April 3rd, 2023
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Peripartum bacterial infection is the leading cause of maternal death worldwide; thus, antibiotic prophylaxis would normally be used. In case a cesarean section is to be performed, intravenous infusion of azithromycin is initiated immediately after labor has started. Due to the positive effect, this practice had been recommended by the American College of Obstetricians and Gynecologists. But it is still unknown whether this practice yields any favorable results in cases of vaginal birth. A study recently published in the New England Journal of Medicine had assessed the effect of peripartum azithromycin on the health of the mother and neonates.
The study included 29,278 women who are at least 28 weeks pregnant and planning to deliver vaginally. The study participants were randomly assigned to receive one tablet containing 2 g of azithromycin or a visually similar placebo. The researchers found that azithromycin helped reduce the risk of maternal sepsis and mortality by 33%. However, there was no difference in the rate of stillbirth, neonatal death or sepsis between the azithromycin and placebo group. The rate of adverse events were similar between the two groups. Thus, intrapartum oral azithromycin can be beneficial for vaginal delivery if the health agency had considered and balanced its benefit against the potential harms in the form of antibiotic resistance and disturbance to the microbiome of the mothers and neonates.
The study included 29,278 women who are at least 28 weeks pregnant and planning to deliver vaginally. The study participants were randomly assigned to receive one tablet containing 2 g of azithromycin or a visually similar placebo. The researchers found that azithromycin helped reduce the risk of maternal sepsis and mortality by 33%. However, there was no difference in the rate of stillbirth, neonatal death or sepsis between the azithromycin and placebo group. The rate of adverse events were similar between the two groups. Thus, intrapartum oral azithromycin can be beneficial for vaginal delivery if the health agency had considered and balanced its benefit against the potential harms in the form of antibiotic resistance and disturbance to the microbiome of the mothers and neonates.