Is it time to add azithromycin for infection prophylaxis at the time of CD?

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  • The addition of azithromycin to cephalosporin at the time of cesarean delivery (CD) may reduce maternal morbidity and overall healthcare costs.

Why this matters

  • Infection complicating CD is a common cause of maternal morbidity and mortality.
  • CD is the most common surgical procedure performed in the United States.

Key results

  • The addition of azithromycin reduced the risk for endometritis (26,600 vs 42,700), wound infection (16,800 vs 46,200), sepsis (22 vs 39), and venous thromboembolism (2532 vs 2540) compared with cephalosporin alone.
  • Cost was lower with the addition of azithromycin ($7504 million vs $8129 million) compared with cephalosporin alone.
  • Maternal mortality and quality-adjusted life-years were similar between groups.

Study design

  • A decision-analytic model was developed using TreeAge Pro 2016 to compare the use of cephalosporin alone with cephalosporin plus azithromycin for infection prophylaxis at the time of CD.
  • A theoretical cohort of 700,000 women undergoing CD was used.
  • Cost data and probabilities of maternal morbidity and mortality were derived from the literature.
  • Funding: None.


  • This is a theoretical study and is subject to unreliable inputs of costs, health outcomes, and utilities.