Two-drug Antibiotic Prophylaxis in Scheduled Cesarean Deliveries

NCT ID: NCT03960970

Last Updated: 2019-09-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

800 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-09-15

Study Completion Date

2020-11-30

Brief Summary

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Cesarean deliveries are the most common surgical procedure performed in the United States. A significant decrease in cesarean delivery associated maternal morbidity has been achieved with preoperative prophylactic single-dose cephalosporin, widely used before skin incision. Also, on laboring patients and/or with rupture of membranes, several studies suggest that adding azithromycin to standard cephalosporin prophylaxis is cost-effective and reduces overall rates of endometritis, wound infection, readmission, use of antibiotics and serious maternal events. Azithromycin has effective coverage against Ureaplasma, associated with increased rates of endometritis. Although two-drug regimen has been suggested for laboring and/or patients that undergo cesarean delivery, no studies have investigated the potential benefits of two-drug regimen in non-laboring patients.

Detailed Description

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Cesarean deliveries are the most common surgical procedure performed in the United States, and scheduled cesarean deliveries account for at least 40% of all cesarean deliveries every year. A significant decrease in cesarean delivery associated maternal morbidity has been achieved with preoperative prophylactic single-dose cephalosporin given within 60 minutes of skin incision. Also, on laboring patients and/or with rupture of membranes, several studies suggest that adding azithromycin to standard cephalosporin prophylaxis is not only cost-effective but reduces overall rates of endometritis and wound infection. Azithromycin provides effective coverage against Ureaplasma, commonly associated with increased rates of endometritis. Although two-drug regimen has been suggested for laboring and/or patients that undergo cesarean delivery, no studies have investigated the potential benefits of two-drug regimen in non-laboring patients. No increase in neonatal morbidity was noted with adjunctive azithromycin prophylaxis, including adverse events.

Conditions

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Endometritis Cesarean Section; Infection Wound Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Pregnant patients admitted to Labor and Delivery unit between June 2019 and July 2020 will be randomized to received either standard prophylaxis or azithromycin and cephalosporin for preoperative prophylaxis after inclusion and exclusion criteria are met and informed consent for participation is signed.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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One-drug Prophylaxis

Mefoxin 2g IV, Piggyback, once

Group Type ACTIVE_COMPARATOR

Mefoxin 2g

Intervention Type DRUG

Standard Prophylaxis

Two-drug Prophylaxis

Mefoxin 2g IV, Piggyback, once and Azithromycin 500mg IV, Piggyback, once

Group Type EXPERIMENTAL

Azithromycin 500 mg

Intervention Type DRUG

Additional IV Azithromycin 500 mg to Standard Prophylaxis

Mefoxin 2g

Intervention Type DRUG

Standard Prophylaxis

Interventions

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Azithromycin 500 mg

Additional IV Azithromycin 500 mg to Standard Prophylaxis

Intervention Type DRUG

Mefoxin 2g

Standard Prophylaxis

Intervention Type DRUG

Other Intervention Names

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Cefoxitin

Eligibility Criteria

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Inclusion Criteria

* Pregnant women 18 years or older
* Women undergoing primary or repeat cesarean delivery
* Singleton gestation
* Gestational age greater than 34 weeks
* Pregnant patients undergoing scheduled cesarean delivery
* Intact membranes
* Non-laboring
* Signed informed consent

Exclusion Criteria

* Maternal age \< 18 years
* Multi-fetal gestation
* Known allergy to cephalosporin or azithromycin
* Patient unwilling or unable to provide consent
* Diagnosis of rupture of membranes
* Intraamniotic infection, or any other active bacterial infection (e.g. pyelonephritis, pneumonia, abscess) at time of randomization.
* Immunocompromising medical conditions: HIV positive with CD4 count below 200, chronic steroid use, current diagnosis of cancer and/or chemotherapy age use
* Emergent cesarean precluding consent or availability of study medication
* Need for hysterectomy at time of delivery
* Use of antibiotic in the 72 hours prior to admission, with exception to patient receiving antibiotics for GBS
* Inability to contact patient on postpartum period.
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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RWJ Barnabas Health at Jersey City Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Tali Wajsfeld

Principal Investigador

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Tali Wajsfeld, MD

Role: PRINCIPAL_INVESTIGATOR

RWJ Barnabas Health at Jersey City Medical Center

Locations

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Jersey City Medical Center

Jersey City, New Jersey, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Tali Wajsfeld, MD

Role: CONTACT

2019152000 ext. 2340

Facility Contacts

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Tali Wajsfeld, MD

Role: primary

201-915-2340

References

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Tita ATN, Rouse DJ, Blackwell S, Saade GR, Spong CY, Andrews WW. Emerging concepts in antibiotic prophylaxis for cesarean delivery: a systematic review. Obstet Gynecol. 2009 Mar;113(3):675-682. doi: 10.1097/AOG.0b013e318197c3b6.

Reference Type BACKGROUND
PMID: 19300334 (View on PubMed)

Andrews WW, Hauth JC, Cliver SP, Savage K, Goldenberg RL. Randomized clinical trial of extended spectrum antibiotic prophylaxis with coverage for Ureaplasma urealyticum to reduce post-cesarean delivery endometritis. Obstet Gynecol. 2003 Jun;101(6):1183-9. doi: 10.1016/s0029-7844(03)00016-4.

Reference Type BACKGROUND
PMID: 12798523 (View on PubMed)

Boggess KA, Tita A, Jauk V, Saade G, Longo S, Clark EAS, Esplin S, Cleary K, Wapner R, Letson K, Owens M, Blackwell S, Beamon C, Szychowski JM, Andrews W; Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium. Risk Factors for Postcesarean Maternal Infection in a Trial of Extended-Spectrum Antibiotic Prophylaxis. Obstet Gynecol. 2017 Mar;129(3):481-485. doi: 10.1097/AOG.0000000000001899.

Reference Type BACKGROUND
PMID: 28178058 (View on PubMed)

Tita AT, Szychowski JM, Boggess K, Saade G, Longo S, Clark E, Esplin S, Cleary K, Wapner R, Letson K, Owens M, Abramovici A, Ambalavanan N, Cutter G, Andrews W; C/SOAP Trial Consortium. Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. N Engl J Med. 2016 Sep 29;375(13):1231-41. doi: 10.1056/NEJMoa1602044.

Reference Type BACKGROUND
PMID: 27682034 (View on PubMed)

Andrews WW, Shah SR, Goldenberg RL, Cliver SP, Hauth JC, Cassell GH. Association of post-cesarean delivery endometritis with colonization of the chorioamnion by Ureaplasma urealyticum. Obstet Gynecol. 1995 Apr;85(4):509-14. doi: 10.1016/0029-7844(94)00436-H.

Reference Type BACKGROUND
PMID: 7898825 (View on PubMed)

Harper LM, Kilgore M, Szychowski JM, Andrews WW, Tita ATN. Economic Evaluation of Adjunctive Azithromycin Prophylaxis for Cesarean Delivery. Obstet Gynecol. 2017 Aug;130(2):328-334. doi: 10.1097/AOG.0000000000002129.

Reference Type BACKGROUND
PMID: 28697108 (View on PubMed)

Tita AT, Hauth JC, Grimes A, Owen J, Stamm AM, Andrews WW. Decreasing incidence of postcesarean endometritis with extended-spectrum antibiotic prophylaxis. Obstet Gynecol. 2008 Jan;111(1):51-6. doi: 10.1097/01.AOG.0000295868.43851.39.

Reference Type BACKGROUND
PMID: 18165392 (View on PubMed)

ACOG Practice Bulletin No. 120: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol. 2011 Jun;117(6):1472-1483. doi: 10.1097/AOG.0b013e3182238c31. No abstract available.

Reference Type BACKGROUND
PMID: 21606770 (View on PubMed)

Skeith AE, Niu B, Valent AM, Tuuli MG, Caughey AB. Adding Azithromycin to Cephalosporin for Cesarean Delivery Infection Prophylaxis: A Cost-Effectiveness Analysis. Obstet Gynecol. 2017 Dec;130(6):1279-1284. doi: 10.1097/AOG.0000000000002333.

Reference Type BACKGROUND
PMID: 29112658 (View on PubMed)

Smith C, Egunsola O, Choonara I, Kotecha S, Jacqz-Aigrain E, Sammons H. Use and safety of azithromycin in neonates: a systematic review. BMJ Open. 2015 Dec 9;5(12):e008194. doi: 10.1136/bmjopen-2015-008194.

Reference Type BACKGROUND
PMID: 26656010 (View on PubMed)

Sutton AL, Acosta EP, Larson KB, Kerstner-Wood CD, Tita AT, Biggio JR. Perinatal pharmacokinetics of azithromycin for cesarean prophylaxis. Am J Obstet Gynecol. 2015 Jun;212(6):812.e1-6. doi: 10.1016/j.ajog.2015.01.015. Epub 2015 Jan 13.

Reference Type BACKGROUND
PMID: 25595580 (View on PubMed)

Smaill FM, Grivell RM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2014 Oct 28;2014(10):CD007482. doi: 10.1002/14651858.CD007482.pub3.

Reference Type BACKGROUND
PMID: 25350672 (View on PubMed)

Other Identifiers

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Prophylaxis Trial

Identifier Type: -

Identifier Source: org_study_id

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