Safety and efficacy of adding single dose adjunctive azithromycin prophylaxis for emergency cesarean delivery

• NANNURI VINDHYAVALI,*  
• SHOBHA SHIRAGUR,  
• SHAILAJA R BIDRI,  
• SHREEDEVI KORI,  
• Rajasri G Yaliwal

Abstract

Introduction: Cesarean sections are on the rise globally, with a higher risk of surgical site infections compared to vaginal deliveries. Recent research suggests adding azithromycin to standard antibiotic prophylaxis may help reduce post-cesarean infections. However, a more comprehensive study is needed to evaluate the safety and efficacy of this approach in emergency cesarean sections. Materials And Methods: In this randomized prospective observational study, 520 pregnant women at ≥28 weeks gestation underwent emergency cesarean section at B.M. Patil Medical College and Research Centre, Vijayapura. They were split into two groups: Group A received azithromycin and standard cephalosporin prophylaxis, while Group B received only ceftriaxone. Exclusion criteria and medical assessments were conducted, and Group A received intravenous azithromycin before the procedure. Post-operative monitoring continued for six weeks, and statistical analysis was performed using JMP-SAS Software. Results: Group A had lower postoperative complication rates than Group B. Group A had 1.5% abnormal cases on the 7th-day follow-up versus 4.6% in Group B (p=0.041). By the 14th day, Group A had 1.14% abnormal cases compared to 3.8% in Group B (p=0.023). Group A also showed lower rates of induration (18.6% vs 29.9%), erythema (10.6% vs 20.3%), NICU admission (7.98% vs 14.2%), and secondary suturing (1.14% vs 3.8%). The mean hospital stay was slightly shorter in Group A (7.67 days vs 7.75 days) but not statistically significant (p=0.477). Conclusion: Adding azithromycin before a cesarean section can improve postoperative outcomes and reduce NICU admissions, but decision-making should be guided by local protocols and individual patient factors.

Keywords

Azithromycin, ceftriaxone, postoperative complications, post-cesarean infections