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

Abstract

Abstract Objective 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. Data sources We searched the PubMed, Embase and Web of Science databases from inception to June 19, 2023. Methods Review Manager 5.4 was used to analyse 6 randomized clinical trials involving 44,448 mothers and 44,820 newborns. Primary outcomes included the incidence of maternal sepsis and all-cause mortality and neonatal sepsis and all-cause mortality; secondary outcomes included maternal (endometritis, mastitis and breast abscess, 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. Results The pooled odds ratios (ORs) were as follows: 0.65 for maternal sepsis (95% CI, 0.55–0.77; I2, 0%; P < 0.00001); 0.62 for endometritis (95% CI, 0.52–0.74; I2, 2%; P < .00001); 0.55 for mastitis and breast abscess (95% CI, 0.34–0.89; I2, 40%; P < .02); and 0.43 for maternal wound or surgical site infection (95% CI, 0.24–0.78; P < .005); however, there was great heterogeneity among the studies (I2, 75%). The pooled OR for pyelonephritis and urinary tract infections was 0.3 (95% CI, 0.17–0.52; I2, 0%; P < .0001), and that for neonatal skin infections was 0.48 (95% CI, 0.35–0.65; I2, 0%, P < .00001). There was no significant difference in maternal all-cause mortality or incidence of chorioamnionitis between the two groups. No significant differences were observed in the incidence of neonatal sepsis or suspected sepsis, all-cause mortality, or infections of the eyes or ears. Conclusion In this meta-analysis, azithromycin use during labour reduced the incidence of maternal sepsis, endometritis, incisional infections, mastitis and breast abscess, and urinary tract infections but did not reduce the incidence of neonatal-associated infections, except for neonatal skin infections.