Single-Dose Azithromycin Prophylaxis in Planned Vaginal Delivery for Sepsis Prevention: A Systematic Review and Meta-analysis of Randomized Controlled Trials [ID 2683483

Abstract

INTRODUCTION: The use of oral azithromycin as a preventive measure against postpartum infections of planned vaginal births has been the subject of many randomized controlled trials. However, the results from these trials have not been consistent. Therefore, performed a systematic review and meta-analysis to determine whether the use of a single-dose of oral azithromycin is clinically significant. METHODS: We systematically searched PubMed, Embase and Cochrane Central for RCTs from May to June 2023, comparing a single dose of oral azithromycin to placebo in patients undergoing planned vaginal delivery at minimum 28 weeks of gestational age. The main outcomes were puerperal and neonatal sepsis. Statistical analyses were performed using Review Manager 5.4.1 (Cochrane Collaboration). Heterogeneity was assessed with I2 statistics. RESULTS: Four randomized controlled trials were included (mothers, n= 42,235; newborns n= 42,492). Approximately 49.8% of mothers received a single dose of oral azithromycin for sepsis prophylaxis. Azithromycin significantly reduced the incidence of puerperal sepsis (risk ratio [RR] 0.65; 95% CI; P<.001), mastitis or breast abscess (RR 0.58; 95% CI; P<.001), endometritis (RR 0.65; 95% CI; P<.001), wound infection (RR 0.81; 95% CI; P=.013), infection rate (RR 0.62; 95% CI; P<.001) and fever (RR 0.50; 95% CI, 0.28–0.89; P=.018) in mothers compared to placebo. CONCLUSION: Azithromycin shows to be an effective preventive measure against many postpartum infections in mothers but a substantial effect on neonatal outcomes has not yet been conclusively observed.