Intrapartum azithromycin to prevent maternal and neonatal sepsis and deaths: A systematic review with meta‐analysis

Abstract

ObjectivesA systematic review with met‐analysis was performed to summarise the evidence on the effect of intrapartum azithromycin on maternal and neonatal infections and deaths.Search strategyPubMed, Scopus and Web of Science databases were searched in March 2023.Selection criteriaRandomised controlled trials comparing intrapartum single‐dose of azithromycin with placebo.Data collection and analysisMaternal infections, maternal mortality, neonatal sepsis, neonatal mortality. We used the random‐effects Mantel–Haenszel method to calculate risk ratios (RR) with 95% confidence intervals (95% CI). We assessed risk of bias of the included studies and estimated the evidence certainty using the GRADE approach.Main resultsAfter screening 410 abstracts, five studies with 44 190 women and 44 565 neonates were included. The risk of bias was low in four and had some concerns in one of the studies. The risk of endometritis was 1.5% in the azithromycin group and 2.3% in the placebo group (RR 0.64, 95% CI 0.55–0.75), and the evidence certainty was high. The respective risk for chorioamnionitis was 0.05% and 0.1% (RR 0.50, 95% CI 0.22–1.18; evidence certainty moderate). The wound infection rate was lower in the azithromycin group (1.6%) than in the placebo group (2.5%), RR 0.52 (95% CI 0.30–0.89; moderate certainty evidence). The maternal sepsis rate was 1.1% in the azithromycin group and 1.7% in the placebo group (RR 0.66, 95% CI 0.56–0.77; evidence certainty high). Mortality rates did not show evidence of a difference (0.09% versus 0.08%; RR 1.26, 95% CI 0.65–2.42; moderate certainty evidence). The neonatal mortality rate was 0.7% in the azithromycin group and 0.8% in the placebo group (RR 0.94, 95% CI 0.76–1.16; moderate certainty evidence). The neonatal sepsis rate was 7.6% in the azithromycin group and 7.4% in the placebo group (RR 1.02, 95% CI 0.96–1.09; moderate certainty evidence).ConclusionsIntrapartum administration of azithromycin to the mother reduces maternal postpartum infections, including sepsis. Impact on maternal mortality remains undecided. Azithromycin does not reduce neonatal sepsis or mortality rates.

Can the use of azithromycin during labour reduce the incidence of infection among puerperae and newborns? A systematic review and meta-analysis of randomized controlled trials

“…The azithromycin group had a lower incidence of maternal sepsis than the placebo group did (RR = 0.65, CI (0.55-0.77)), but there was no statistically signi cant difference between the two groups in terms of maternal all-cause mortality, neonatal sepsis or all-cause mortality. Two recent systematic reviews [19,20] showed that the addition of a single dose of azithromycin at the time of delivery was associated with a lower risk of maternal sepsis but was not associated with maternal mortality, neonatal mortality, neonatal sepsis or suspected neonatal sepsis. The ndings of our systematic review are consistent with those of Tita et al's [13] research and two previous systematic reviews.…”

Can the use of azithromycin during labour reduce the incidence of infection among puerperae and newborns? A systematic review and meta-analysis of randomized controlled trials

“…This discrepancy may arise from the fact that azithromycin is not widely used in Africa [ 15 ]. Two recent systematic evaluations [ 22 , 23 ] have shown that the addition of a single dose of azithromycin at the time of delivery is associated with a reduced risk of maternal sepsis. One of them evaluated indicators related to the prophylactic oral administration of a single dose of azithromycin antenatally in women with planned vaginal deliveries.…”