Single dose of azithromycin reduces maternal sepsis or death

UAB News, by Hannah Echols, February 9, 2023

A-PLUS co-leads Alan Tita, M.D., Ph.D. and Waldemar A. Carlo, M.D. Photography: Andrea Mabry
A-PLUS co-leads Alan Tita, M.D., Ph.D. and Waldemar A. Carlo, M.D.
Photography: Andrea Mabry.

Ten percent of maternal deaths are caused by infections that occur shortly before, during or after delivery. Maternal infections and sepsis, which is a serious complication of infections, are among the top five causes of maternal mortality worldwide. Maternal infection also increases the risk of neonatal sepsis, which accounts for 16 percent of newborn deaths.

A new study published today in the New England Journal of Medicine provides evidence that a single oral dose of azithromycin, a common antibiotic, reduced the risk of maternal sepsis or death by 33 percent in women who delivered vaginally. The results from the Azithromycin Prevention in Labor Use Study, or A-PLUS, trial led by investigators at the University of Alabama at Birmingham enhances information from previous UAB-led trials, which showed azithromycin administered before cesarean delivery reduced maternal infections.

The multi-country, randomized trial was conducted at eight sites in seven low- and middle-income countries in Africa, Asia and Latin America. The study was funded by the National Institutes of Health and the Bill & Melinda Gates Foundation and conducted by the NICHD Global Network for Women’s and Children’s Health Research. Published results were presented simultaneously at the Society for Maternal-Fetal Medicine’s annual meeting in San Francisco, California.

“The World Health Organization and others have prioritized reducing maternal sepsis to reduce maternal deaths,” said Alan Tita, M.D., Ph.D., professor in the UAB Department of Obstetrics and Gynecology and director of the UAB Center for Women’s Reproductive Health and Mary Heersink Institute for Global Health, and associate dean for Global and Women’s Health. “Studies confirming the effectiveness of azithromycin for vaginal delivery, which is the most common mode of delivery, were lacking. We wanted to find a low-cost intervention that could be used globally to address this problem.”