The 2016 trial behind this practice added a single dose of azithromycin 500 mg intravenously to standard cephalosporin prophylaxis in women having a non-elective caesarean during labour or at least four hours after membrane rupture. It is extended-spectrum cover against Ureaplasma and other organisms colonising the uterus in labour, not a replacement for cefazolin. It does not apply to elective caesarean before labour, which the trial did not study.
- Eligible: caesarean in labour, or 4+ hours after rupture of membranes
- Dose: azithromycin 500 mg IV once, in addition to cefazolin
- Give before incision, alongside standard prophylaxis
- Not indicated for scheduled caesarean before labour
Why it matters
The addition is cheap and single-dose, and it only applies to caesareans done in labour or after membrane rupture.
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