TY - JOUR
T1 - Intrapartum and postpartum antibiotic use in seven low- and middle-income countries
T2 - Findings from the A-PLUS trial
AU - Saleem, Sarah
AU - Yasmin, Haleema
AU - Moore, Janet L.
AU - Rahim, Anum
AU - Shakeel, Iram
AU - Lokangaka, Adrien
AU - Tshefu, Antoinette
AU - Bauserman, Melissa
AU - Mwenechanya, Musaku
AU - Chomba, Elwyn
AU - Goudar, Shivaprasad S.
AU - Kavi, Avinash
AU - Derman, Richard J.
AU - Krebs, Nancy F.
AU - Figueroa, Lester
AU - Mazariegos, Manolo
AU - Nyongesa, Paul
AU - Bucher, Sherri
AU - Esamai, Fabian
AU - Patel, Archana
AU - Waikar, Manjushree
AU - Shivkumar, Poonam
AU - Hibberd, Patricia L.
AU - Petri, William A.
AU - Billah, Sk Masum
AU - Haque, Rashidul
AU - Carlo, Waldemar A.
AU - Tita, Alan
AU - Koso-Thomas, Marion
AU - Hemingway-Foday, Jennifer
AU - McClure, Elizabeth M.
AU - Goldenberg, Robert L.
N1 - Publisher Copyright:
© 2024 John Wiley & Sons Ltd.
PY - 2025/1
Y1 - 2025/1
N2 - Objective: To describe the intrapartum and postpartum use of non-study antibiotics in low- and middle-income countries (LMICs) during the double-blinded NICHD Global Network Azithromycin in Labor (A-PLUS) trial. Design: The antibiotic use sub-study was a planned prospective, observational sub-study of the A-PLUS trial. Settings: The study was carried out in hospitals or health centres affiliated with eight sites of the Global Network for Women's and Children's Health Research (Global Network) in seven countries: Bangladesh, Pakistan, India (two sites), Kenya, Zambia, The Democratic Republic of the Congo (DRC) and Guatemala. Population: Totally, 29 278 pregnant women enrolled in the A-PLUS trial. Methods: We collected data on 29 278 pregnant women admitted to a facility for delivery related to non-study antibiotic use overall and during three time periods: (1) in the facility prior to delivery, (2) after delivery until facility discharge and (3) after discharge to 42 days post-partum. Main Outcome Measures: Non-study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods. Results: Of the 29 278 women in the study, 5020 (17.1%; 95% CI 16.7%–17.6%) received non-study antibiotics in the facility prior to delivery, 11 956 (40.8%; 95% CI 40.3%–41.4%) received non-study antibiotics in the facility after delivery, and 13 390 (47.6%; 95% CI 47.0%–48.2%) women received non-study antibiotics after delivery and after facility discharge. Antibiotics were prescribed more often among women in the Asian and Guatemalan sites than in the African sites. In the three time-periods, among those receiving antibiotics, prophylaxis was the indication in 82.3%, 97.7% and 90.7% of the cases, respectively. The type of antibiotics used varied substantially by time-period and site, but generally, penicillin-type drugs, cephalosporin-type drugs and metronidazole were used more frequently than other types. Conclusions: Across the eight sites of the Global Network, in the facility before delivery, and in the post-partum periods before and after facility discharge, antibiotics were used frequently, but use was highly variable by site and time-period.
AB - Objective: To describe the intrapartum and postpartum use of non-study antibiotics in low- and middle-income countries (LMICs) during the double-blinded NICHD Global Network Azithromycin in Labor (A-PLUS) trial. Design: The antibiotic use sub-study was a planned prospective, observational sub-study of the A-PLUS trial. Settings: The study was carried out in hospitals or health centres affiliated with eight sites of the Global Network for Women's and Children's Health Research (Global Network) in seven countries: Bangladesh, Pakistan, India (two sites), Kenya, Zambia, The Democratic Republic of the Congo (DRC) and Guatemala. Population: Totally, 29 278 pregnant women enrolled in the A-PLUS trial. Methods: We collected data on 29 278 pregnant women admitted to a facility for delivery related to non-study antibiotic use overall and during three time periods: (1) in the facility prior to delivery, (2) after delivery until facility discharge and (3) after discharge to 42 days post-partum. Main Outcome Measures: Non-study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods. Results: Of the 29 278 women in the study, 5020 (17.1%; 95% CI 16.7%–17.6%) received non-study antibiotics in the facility prior to delivery, 11 956 (40.8%; 95% CI 40.3%–41.4%) received non-study antibiotics in the facility after delivery, and 13 390 (47.6%; 95% CI 47.0%–48.2%) women received non-study antibiotics after delivery and after facility discharge. Antibiotics were prescribed more often among women in the Asian and Guatemalan sites than in the African sites. In the three time-periods, among those receiving antibiotics, prophylaxis was the indication in 82.3%, 97.7% and 90.7% of the cases, respectively. The type of antibiotics used varied substantially by time-period and site, but generally, penicillin-type drugs, cephalosporin-type drugs and metronidazole were used more frequently than other types. Conclusions: Across the eight sites of the Global Network, in the facility before delivery, and in the post-partum periods before and after facility discharge, antibiotics were used frequently, but use was highly variable by site and time-period.
KW - A-PLUS trial
KW - infection
KW - low- and middle-income countries
KW - maternal antibiotics
KW - pregnancy
UR - https://www.scopus.com/pages/publications/85201149071
U2 - 10.1111/1471-0528.17930
DO - 10.1111/1471-0528.17930
M3 - Article
AN - SCOPUS:85201149071
SN - 1470-0328
VL - 132
SP - 72
EP - 80
JO - BJOG: An International Journal of Obstetrics and Gynaecology
JF - BJOG: An International Journal of Obstetrics and Gynaecology
IS - 1
ER -