Maternal sepsis and death greatly reduced by single-dose antibiotic
According to a recent large, multi-country clinical trial, the risk of postpartum sepsis and death in women who plan to deliver vaginally can be reduced by one-third by administering a single dose of the antibiotic azithromycin.
Azithromycin is a low-cost, broad-spectrum antibiotic that is commonly used to treat a wide variety of bacterial infections such as respiratory infections, skin infections, ear, nose and throat infections and sexually transmitted diseases (STDs).
Although highly preventable, sepsis is the leading cause of maternal and newborn deaths worldwide, particularly in low- and middle-income countries. It is usually caused by a severe prenatal bacterial infection of the uterus or infection immediately after childbirth and can result in life-threatening organ dysfunction.
The randomized controlled Azithromycin-Prevention in Labor Use Study (A-PLUS) enrolled 29,278 women from low- and middle-income countries who planned to have a vaginal birth. Women were drawn from countries that included Bangladesh, Guatemala, India, Pakistan, and Zambia. The National Institutes of Health (NIH) and the Bill and Melinda Gates Foundation co-funded the study.
The study found that of those women given a two-gram oral dose of azithromycin during labor, only 1.6% developed sepsis or died in the six-week period after delivery, compared with 2.4% of women in the placebo group. Results also showed that women administered azithromycin were less likely to develop endometriosis and had fewer hospital readmissions and unscheduled visits to health professionals compared to women that received the placebo.
Azithromycin had no noticeable effect on the risk of stillbirth, newborn sepsis, or newborn death, which remained comparable between the azithromycin group (10.5%) and the placebo group (10.3%).
“We hope that our findings will be applied to help improve maternal care in low- and middle-income countries around the globe,” said Alan Tita, MD, PhD, who co-led the trial.
“These findings have the potential to change clinical practice by providing a safe, effective and low-cost approach to reduce the global burden of maternal sepsis and death,” said Dr Diana Bianchi, director of NIH’s National Institute of Child Health and Development (NICHD), the primary funder of the trial.
"We urgently need effective strategies to prevent pregnancy-related infections, which account for roughly 10% of maternal deaths worldwide," Dr Bianchi said.
The study was recently published in The New England Journal of Medicine.
Source: National Institutes of Health