Obstetrics & Gynecology · 3 h ago
Azithromycin Use After Unscheduled Cesarean Delivery Increased After 2016 Trial Evidence
A US difference-in-differences analysis of 1,663,441 singleton deliveries from 2013 to 2024 examined azithromycin use and postpartum infections after unscheduled cesarean delivery. Following publication of trial evidence in 2016, perioperative azithromycin use rose substantially, while postpartum infection rates declined relative to vaginal births.
- Azithromycin use rose to 39.6% after trial publication.
- Use increased by an adjusted 37.6 percentage points.
- Postpartum infections declined relative to vaginal births.
- Observational findings do not establish causation.
Researchers used Epic Cosmos data to study pregnant individuals who received prenatal care, labored, and delivered a liveborn singleton at 24 to 43 weeks’ gestation from 2013 through 2024. The analysis included 202,234 cesarean births and 1,461,207 vaginal births. Using vaginal births as a comparison group, the investigators assessed changes after publication of trial evidence supporting adjunctive azithromycin for unscheduled cesarean delivery. Outcomes were perioperative azithromycin administration and postpartum infection within six weeks of delivery.
Azithromycin use during cesarean births increased from 2.2% before the trial publication to 39.6% afterward; use during vaginal births remained very low. The adjusted difference-in-differences estimate was 37.6 percentage points (95% CI, 33.1 to 42.2). Postpartum infection occurred after 9.2% of cesarean births before publication and 8.0% afterward, compared with 2.0% and 2.7% of vaginal births, respectively. The adjusted difference-in-differences estimate was −2.0 percentage points (95% CI, −2.6 to −1.4).
The findings show increased uptake of the trial-supported intervention alongside a relative decline in infections. This observational analysis does not establish that increased azithromycin use caused the decline; results may also be affected by changes over time or limitations in the electronic health record data.
In practice
For clinicians caring for patients undergoing unscheduled cesarean delivery, this large US study indicates that perioperative azithromycin use increased after publication of trial evidence supporting its use, reaching 39.6% of cesarean births in 2017–2024. Postpartum infection rates also declined relative to vaginal births. These data describe adoption and trends rather than treatment effects: the observational difference-in-differences design cannot establish that increased azithromycin use caused the decline, and the supplied report does not provide details on patient-level eligibility or reasons for treatment decisions.
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JAMA: Adoption of Adjunctive Azithromycin for Unscheduled Cesarean Delivery and Postpartum Infections ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.