Adoption of Adjunctive Azithromycin for Unscheduled Cesarean Delivery and Postpartum Infections.

After 2016 trial evidence, perioperative azithromycin use for unscheduled cesarean delivery rose to 37.6 percentage points versus vaginal births, while postpartum infection fell by 2.0 points.

• Why it matters: Trial results exist for unscheduled cesarean delivery, but real-world adoption and whether postpartum infection trends followed the evidence in US practice were previously unreported.
• What they did: Using Epic Cosmos data (2013–2024) and a difference-in-differences design comparing cesarean vs vaginal births, the study measured perioperative azithromycin administration and postpartum infection within 6 weeks.
• The result: Azithromycin administration increased from 2.2% (721/32,970) to 39.6% (67,094/169,264) for cesareans, and postpartum infection decreased from 9.2% (3048/32,970) to 8.0% (13,555/169,264), with adjusted estimates of 37.6 and -2.0 percentage points, respectively.

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