Efficacy of Adding Azithromycin to Cephalosporin for the Prophylaxis Against Infectious Morbidity Following Cesarean Delivery in high risk women: Randomized Controlled Trial

Abstract

esarean delivery is one of the commonly performed surgical procedures in obstetrics. Cesarean rates in Egypt rose from 4.6% to 51.8% over the 24 years period from 1990 till 2014. Therefore it is associated with higher rates of maternal infection, rehospitalization and postpartum medical care utilization. Recently multicenter, randomized trials found that there were fewer cases of endometritis and wound infection among laboring women who received adjunctive azithromycin 2 hours before skin incision compared with active control (all received a cephalosporin) Azithromycin is a bacteriostatic macrolide antibiotic and like other macrolides inhibits synthesis of protein by binding reversibly to 50s ribosomal subunits of sensitive microorganisms, at or very close to the site that binds chloramphenicol. It does not inhibit peptide bond formation per se, but rather inhibit the translocation step where a recently formed peptidyl + RNA travels from the acceptor site on the ribosome to the peptidyl donor site (NIPA). The aim of work is to investigate the efficacy of adding azithromycin to cephalosporin for the prophylaxis against wound infection which is considered primary outcome,