Efficacy of adding azithromycin to antibiotic prophylaxis in caesarean delivery: a meta-analysis and systematic review

To explore the efficacy of adding azithromycin to antibiotic prophylaxis for patients undergoing caesarean delivery (CD), we conducted a statistical analysis of related randomised controlled trials (RCTs) and cohort studies in the existing literature. Studies that used the same study design and outcome indicators were included in our meta-analysis. We then carried out heterogeneity tests and effect quantity calculation. Our meta-analysis of RCTs showed that addition of azithromycin as prophylaxis in CD significantly reduced the risk of endometritis [relative risk (RR) = 0.62, 95% confidence interval (CI) 0.49-0.79; P < 0.0001] and wound infection (RR = 0.40, 95% CI 0.27-0.58; P < 0.00001). In addition, meta-analysis results of the cohort studies also confirmed the efficacy of azithromycin for endometritis (RR = 0.41, 95% CI 0.11-1.51; P = 0.18), wound infection (RR = 0.66, 95% CI 0.54-0.82; P = 0.0001) and composite infections outcome (RR = 0.80, 95% CI 0.66-0.96; P = 0.02). However, meta-analysis could not be used to evaluate the safety of adding azithromycin owing to inconsistencies in the outcome indicators used in different studies. Addition of azithromycin to antibiotic prophylaxis reduced the risk of surgical site infections in patients undergoing CD. However, additional subgroup studies involving non-elective CD and long-term follow-up studies on the safety of the offspring are required in the future.