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

• Author Details:   
• Nannuri Vindhyavali ^*
• Shobha Shiragur
• Shailaja R Bidri
• Shreedevi Kori
• Rajasri G Yaliwal

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Background: 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.