Are prophylactic adjunctive macrolides efficacious against caesarean section surgical site infection: A systematic...

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Pharmacology

Background:

• Surgical site infections (SSI) following caesarean sections (CS) represent a significant clinical challenge.
• Prophylactic macrolide antibiotics are being investigated as an adjunctive therapy to reduce SSI rates.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness of adjunctive prophylactic macrolides in reducing endometritis and wound infections post-CS.

Main Methods:

• A comprehensive search of MEDLINE, EMBASE, CINAHL, and Cochrane Library was conducted up to July 2018.
• Included studies were observational or randomized, comparing standard antibiotics with adjunctive macrolides for SSI outcomes.
• Data extraction was performed by two reviewers, and meta-analysis was conducted for studies with similar designs and outcomes, assessing heterogeneity using the I² test.

Main Results:

• Five studies were included in the review; four in the meta-analysis.
• Randomized controlled trials (RCTs) demonstrated significant reductions in wound infection (RR [0.34; 95%, 0.22-0.53]) and endometritis (RR [0.66; 95%, 0.52-0.85]) with no heterogeneity.
• Cohort studies indicated azithromycin significantly reduced endometritis risk (RR [0.16; 95%, 0.04-0.62]), though with significant heterogeneity.

Conclusions:

• Adjunctive prophylactic macrolides are effective in significantly lowering the incidence of endometritis and wound infections after caesarean sections.
• Further investigation into the optimal timing of macrolide administration, such as post-cord clamping, is warranted to address potential fetal antibiotic exposure and long-term infant implications.