PeRinatal, neOnatal, and Maternal OuTcomEs with azithromycin prophylaxis in pregnancy and labour (PROMOTE-PROPHYLAXIS): systematic review and meta-analysis

Muhammad Aaqib Shamim(All India Institute of Medical Sciences Jodhpur), Jogender Kumar(Post Graduate Institute of Medical Education and Research), Amol Patil(Post Graduate Institute of Medical Education and Research), Krishna Raj Tiwari(All India Institute of Medical Sciences Jodhpur), Sakshi Sharma(Government Dental College and Hospital), Abhishek Anil(All India Institute of Medical Sciences Jodhpur), Aswini Saravanan(All India Institute of Medical Sciences Jodhpur), Mokanpally Sandeep(University of Hyderabad), Shoban Babu Varthya(All India Institute of Medical Sciences Jodhpur), Surjit Singh(All India Institute of Medical Sciences Jodhpur), Molla Imaduddin Ahmed(University Hospitals of Leicester NHS Trust), Ahmad Najmi(All India Institute of Medical Sciences Bhopal), Muhammad Aasim Shamim(All India Institute of Medical Sciences Jodhpur), Aravind P. Gandhi(All India Institute of Medical Sciences, Nagpur), Prakasini Satapathy(Saveetha University), Ranjit Sah(Dr. D.Y. Patil Vidyapeeth, Pune), Sarvesh Rustagi(Uttaranchal University), Abhay Gaidhane(Datta Meghe Institute of Higher Education and Research), Quazi Syed Zahiruddin(Datta Meghe Institute of Higher Education and Research), Mahalaqua Nazli Khatib(Datta Meghe Institute of Higher Education and Research), Bijaya Kumar Padhi(Post Graduate Institute of Medical Education and Research), Kuldeep Singh(All India Institute of Medical Sciences Jodhpur), Pradeep Dwivedi(All India Institute of Medical Sciences Jodhpur)
EClinicalMedicine
June 21, 2024
10.1016/j.eclinm.2024.102691
Cited by 14Open Access
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Abstract

Background: Initial randomised controlled trials (RCTs) showed that prophylactic azithromycin in pregnant women improved maternal and neonatal outcomes; however, the recent evidence did not show any benefit to neonatal survival. There is conflicting evidence over the role of azithromycin prophylaxis in antenatal and intrapartum periods. We explored whether azithromycin prophylaxis in pregnant women improves maternal and neonatal outcomes. Methods: For this systematic review and meta-analysis registered on PROSPERO [CRD42023411093], we searched seven databases (PubMed, Scopus, Embase, Cochrane Library, EBSCOHost, ProQuest, and Web of Science) and clinical trial registries until 04/23/2024, for RCTs evaluating antenatal/intrapartum azithromycin prophylaxis against placebo/routine care in pregnant women. The primary outcome was neonatal mortality. Intrapartum and antenatal administration were assessed separately. We used random-effects meta-analysis. The risk of bias was assessed using the Cochrane RoB 2 tool. The GRADE approach was used to evaluate the certainty of the evidence. Findings: = 0%, low certainty]. There is no data on long-term adverse outcomes and antimicrobial resistance. Interpretation: Low to very low certainty evidence suggests that intrapartum or antenatal azithromycin prophylaxis in pregnant women might not reduce maternal or neonatal mortality. Funding: None.

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