Addition of azithromycin to the routine pre-cesarean prophylaxisagainst infection, effective or not?

Purpose: There is debatable data regarding the addition of azithromycin to the routine antibiotic prophylaxis of post-cesarean section (CS)infection. In this work, we tried to evaluate its potential benefit to protect against both post-cesarean maternal and fetalinfections.Methods: The study included 230 women who were intended to haveselective CS at Mansoura university hospital. They were randomlysubdivided into115 women that received azithromycin plus standardcephalosporin and another115 women that received standard cephalosporin alone. The main outcome is evaluation of post-cesarean sectioninfection as endometritis, wound sepsis, etc… across the puerperal period. Results: In comparison between the test group and the control group,there was significant reduction of re-admission during puerperium(0%vs 6.5%, p=0.01). Endometritis manifestations were significantly reduced, including: puerperal Fever >38OC (4.3% versus 15.2%), uterine tenderness (3.2% versus 11.9%), abdominal pain (1.1% versus14.1%), offensive vaginal discharge (2.1% versus 13%) and purulentdrainage from uterus (2.1% versus 9.8%). Wound infection manifestations were significantly reduced, including; erythema around incision(2.1%versus 8.7), induration around incision (3.2 versus 12%) and purulent discharge from incision site (1.1% versus 9.8%). Also, the needfor further antibiotic during puerperium was significantly reduced(3.2% versus 11.9%). There was no significant difference between the2 groups regarding neonatal outcomes.Conclusion: Azithromycin plus the standard cephalosporin administered to women in selective CS reduces maternal infections and maternal episodes of fever, with no clear benefit on the neonatal outcome