Comparison between preventive antibiotic regimes of cefazolin with or without Azithromycin in cesarean surgical site infection

Wound infection is not uncommon after cesarean sections. Using a first-generation cephalosporin (cefazolin) has been recommended for antibiotic prophylaxis in patients, but according to few reports, extending the spectrum of antibiotic prophylaxis by adding azithromycin to the standard cephalosporin may lead to extra protection against postcesarean infections. The relevant available data are not enough to draw a solid conclusion. This study aimed to compare the effectiveness of conventional antibiotic prophylaxis using cefazolin with a combination of cefazolin and azithromycin in reducing wound infection.
In this randomized clinical trial, candidates of cesarean section were categorized in two groups; cases (n=85) who received intraoperative cefazolin plus postoperative oral azithromycin (500 gr) and controls (n=86) who received intraoperative cefazolin only. The incidence rate of surgical wound infection by 30 days postoperation was compared between the two groups.
Cesarean sections were emergency in 80% of cases and 89.5% of controls (p=0.08). Postcesarean incisional wound infection developed in 4.7% of controls, whereas no patient in the case group had such infection (p=0.12).
Compared to cefazolin alone, a combination of azithromycin and cefazolin was more effective in preventing postcesarean incisional wound infection, the difference was not significant. Nonetheless, owing to this advantageous clinical consequence using a combination of these two antibiotics instead of cefazolin alone is recommended.