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.
Infant, Newborn
Pregnancy
Female
Humans
Azithromycin
/ therapeutic use
Neonatal Sepsis
/ epidemiology
Cesarean Section
Chorioamnionitis
/ drug therapy
Endometritis
/ epidemiology
Incidence
Randomized Controlled Trials as Topic
Sepsis
/ epidemiology
Puerperal Infection
/ epidemiology
Surgical Wound Infection
Urinary Tract Infections
/ epidemiology
Azithromycin
Infection
Labour
Newborns
Puerperae
Sepsis
Journal
BMC pregnancy and childbirth
ISSN: 1471-2393
Titre abrégé: BMC Pregnancy Childbirth
Pays: England
ID NLM: 100967799
Informations de publication
Date de publication:
14 Mar 2024
14 Mar 2024
Historique:
received:
20
12
2023
accepted:
04
03
2024
medline:
18
3
2024
pubmed:
15
3
2024
entrez:
15
3
2024
Statut:
epublish
Résumé
This systematic review and meta-analysis investigated whether the use of azithromycin during labour or caesarean section reduces the incidence of sepsis and infection among mothers and newborns. We independently searched the PubMed, Web of Science, Cochrane Library and EMBASE databases for relevant studies published before February, 2024. We included RCTs that evaluated the effect of prenatal oral or intravenous azithromycin or placebo on intrapartum or postpartum infection incidence. We included studies evaluating women who had vaginal births as well as caesarean sections. Studies reporting maternal and neonatal infections were included in the current analysis. Review Manager 5.4 was used to analyse 6 randomized clinical trials involving 44,448 mothers and 44,820 newborns. The risk of bias of each included study was assessed using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions.Primary outcomes included the incidence of maternal sepsis and all-cause mortality and neonatal sepsis and all-cause mortality; secondary outcomes included maternal (endometritis, wound and surgical site infections, chorioamnionitis, and urinary tract infections) and neonatal outcomes (infections of the eyes, ears and skin). A random-effects model was used to test for overall effects and heterogeneity. The pooled odds ratios (ORs) were as follows: 0.65 for maternal sepsis (95% CI, 0.55-0.77; I In this meta-analysis, azithromycin use during labour reduced the incidence of maternal sepsis, endometritis, incisional infections and urinary tract infections but did not reduce the incidence of neonatal-associated infections, except for neonatal skin infections. These findings indicate that azithromycin may be potentially beneficial for maternal postpartum infections, but its effect on neonatal prognosis remains unclear. Azithromycin should be used antenatally only if the clinical indication is clear and the potential benefits outweigh the harms.
Identifiants
pubmed: 38486177
doi: 10.1186/s12884-024-06390-6
pii: 10.1186/s12884-024-06390-6
pmc: PMC10938810
doi:
Substances chimiques
Azithromycin
83905-01-5
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
200Informations de copyright
© 2024. The Author(s).
Références
Lancet. 2010 Jun 5;375(9730):1969-87
pubmed: 20466419
N Engl J Med. 2023 Mar 30;388(13):1161-1170
pubmed: 36757318
PLoS Med. 2009 Jul 21;6(7):e1000100
pubmed: 19621070
PLoS One. 2016 Jun 21;11(6):e0157045
pubmed: 27326859
Am J Obstet Gynecol. 2008 Sep;199(3):303.e1-3
pubmed: 18771992
Cochrane Database Syst Rev. 2014 Oct 28;(10):CD007482
pubmed: 25350672
Obstet Gynecol. 2021 Nov 1;138(5):703-713
pubmed: 34619734
Obstet Gynecol. 2018 Sep;132(3):e103-e119
pubmed: 30134425
Cochrane Database Syst Rev. 2019 Oct 3;10:ED000142
pubmed: 31643080
Clin Microbiol Infect. 2016 Jun;22(6):565.e1-9
pubmed: 27026482
Pediatr Int. 2019 Jan;61(1):58-62
pubmed: 30460724
Obstet Gynecol. 2017 Aug;130(2):328-334
pubmed: 28697108
Reprod Toxicol. 2021 Mar;100:101-108
pubmed: 33454317
BMJ. 2003 Sep 6;327(7414):557-60
pubmed: 12958120
Lancet. 2005 Mar 5-11;365(9462):891-900
pubmed: 15752534
Lancet Glob Health. 2014 Jun;2(6):e323-33
pubmed: 25103301
Pharmacol Ther. 2014 Aug;143(2):225-45
pubmed: 24631273
Obstet Gynecol. 2003 Jun;101(6):1183-9
pubmed: 12798523
Obstet Gynecol. 2008 Jan;111(1):51-6
pubmed: 18165392
mSphere. 2020 Feb 19;5(1):
pubmed: 32075882
Lancet. 2015 Jan 31;385(9966):430-40
pubmed: 25280870
NEJM Evid. 2022 Apr;1(4):EVIDoa2100054
pubmed: 35692260
Int J Gynaecol Obstet. 2024 Apr;165(1):107-116
pubmed: 37724021
Curr Opin Infect Dis. 2010 Jun;23(3):249-54
pubmed: 20375891
Expert Opin Drug Metab Toxicol. 2011 Sep;7(9):1153-67
pubmed: 21736423
Am J Obstet Gynecol. 2019 Dec;221(6):648.e1-648.e15
pubmed: 31260651
Arch Gynecol Obstet. 2020 Jul;302(1):5-22
pubmed: 32409925
Am J Obstet Gynecol. 2022 Jun;226(6):794-801.e1
pubmed: 34973176
BJOG. 2024 Feb;131(3):246-255
pubmed: 37691261
Pediatr Infect Dis J. 2002 May;21(5):375-80
pubmed: 12150171
J Family Med Prim Care. 2019 Sep 30;8(9):3015-3021
pubmed: 31681684
CMAJ. 2017 May 1;189(17):E625-E633
pubmed: 28461374
Pediatrics. 2017 Feb;139(2):
pubmed: 28130432
Am J Obstet Gynecol. 2001 Mar;184(4):656-61
pubmed: 11262468
Lancet. 2009 Dec 5;374(9705):1909-16
pubmed: 19846212
JAMA. 2023 Mar 7;329(9):716-724
pubmed: 36881034
Clin Drug Investig. 2022 Nov;42(11):921-935
pubmed: 36152269
N Engl J Med. 2016 Sep 29;375(13):1231-41
pubmed: 27682034