A Proven C-Section Antibiotic Finally Caught On. Infections Dropped.
In 2016, a large clinical trial showed that adding azithromycin to the standard antibiotic given before an unscheduled cesarean section cut postpartum infection rates significantly. A new JAMA study tracked what happened across approximately 1.7 million US deliveries between 2013 and 2024 to see whether hospitals actually changed their practice.
They did, but not all of them. Azithromycin use at unscheduled c-sections rose from roughly 2 percent before the trial to about 60 percent by 2024. Postpartum infection rates following c-sections fell from approximately 9 percent to 8 percent over the same period. That decline tracks with where and when the drug’s use increased.
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Four in ten unscheduled c-sections still did not include the drug by the end of the study period. And infection rates among vaginal deliveries moved in the opposite direction during those same years. Both findings carry implications that are specific to women planning or facing a cesarean.
The 40 percent non-adoption rate represents a large number of deliveries each year where a proven, inexpensive intervention is being skipped. The study did not fully characterize the reasons, but the authors point to variation in hospital protocols and awareness of the 2016 trial as likely contributors. The gap between available evidence and clinical practice is the central finding here.
The concurrent rise in infections among vaginal births is a separate and unexplained trend. The authors flag it as a signal worth investigating but do not attribute it to azithromycin use. For women expecting a c-section, whether scheduled or unscheduled, it is reasonable to ask their care team whether azithromycin will be part of the antibiotic protocol.
Source: Tita et al., “Trends in Azithromycin Use and Postpartum Infections After Cesarean Delivery,” JAMA