Azithromycin uptake may reduce postcesarean infections

Trial evidence translated into wider clinical use as postpartum infection rates declined in US practice.

Category	Detail
Condition	Postcesarean infections
Key Mechanisms	Adjunctive azithromycin use
Target Population	Patients undergoing unscheduled cesarean delivery
Care Setting	Clinical practice in the United States

Azithromycin use increased from 2% to 40% among cesarean deliveries post-2016.
Postpartum infection rates decreased from 9% to 8% following cesarean delivery.
Components of infection composite, including endometritis and sepsis, declined.
Vaginal delivery infections increased from 2% to 3% during the same period.
Real-world reduction in infection was smaller than reported in the C/SOAP trial.

Monitor for postpartum infections including endometritis, sepsis, and wound infections.

Consider adjunctive azithromycin for patients undergoing unscheduled cesarean delivery.

Potential for residual confounding due to contemporaneous infection-prevention measures.

Patients with live-born singleton pregnancies undergoing cesarean delivery.

Less than 50% of cesarean delivery patients received azithromycin post-publication.

Clinical Scorecard: Azithromycin uptake may reduce postcesarean infections