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Can We Better Prevent Postpartum Infections After Cesarean Delivery?

Despite routine antibiotic prophylaxis with cephalosporin prior to incision, the risk of postpartum infection after cesarean delivery is 5 to 10 times greater than after vaginal delivery. The suspected pathogens in such infections are bacteria of the ureaplasma species. Penicillins and cephalosporins are ineffective against such bacteria, but they are susceptible to azithromycin. This poses an interesting question: Would antibiotic prophylaxis with azithromycin help reduce the rate of postpartum infection after cesarean delivery?

A multicenter, randomized study recently published in the New England Journal of Medicine investigated this question. Patients undergoing non-elective cesarean delivery were given either placebo or adjunctive antibiotic prophylaxis with azithromycin in addition to standard prophylaxis with a cephalosporin (cefazolin). Those who received adjunctive therapy with azithromycin had significantly lower rates of postpartum infections (such as endometritis, superficial and deep surgical wound infections, abdominopelvic abscess) when compared to those who received standard prophylaxis only. Thus, it does indeed appear that addition of azithromycin to standard antibiotic prophylaxis reduces the risk of certain postpartum infections after non-elective cesarean delivery.