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Randomized Controlled Trial
. 2025 Jan;132(1):72-80.
doi: 10.1111/1471-0528.17930. Epub 2024 Aug 14.

Intrapartum and postpartum antibiotic use in seven low- and middle-income countries: Findings from the A-PLUS trial

Sarah Saleem  1 , Haleema Yasmin  2 , Janet L Moore  3 , Anum Rahim  1 , Iram Shakeel  1 , Adrien Lokangaka  4 , Antoinette Tshefu  4 , Melissa Bauserman  5 , Musaku Mwenechanya  6 , Elwyn Chomba  6 , Shivaprasad S Goudar  7 , Avinash Kavi  7 , Richard J Derman  8 , Nancy F Krebs  9 , Lester Figueroa  10 , Manolo Mazariegos  10 , Paul Nyongesa  11 , Sherri Bucher  12 , Fabian Esamai  11 , Archana Patel  13   14 , Manjushree Waikar  15 , Poonam Shivkumar  16 , Patricia L Hibberd  17 , William A Petri  18 , Sk Masum Billah  19   20 , Rashidul Haque  19 , Waldemar A Carlo  21 , Alan Tita  21 , Marion Koso-Thomas  22 , Jennifer Hemingway-Foday  3 , Elizabeth M McClure  3 , Robert L Goldenberg  23
Affiliations
Randomized Controlled Trial

Intrapartum and postpartum antibiotic use in seven low- and middle-income countries: Findings from the A-PLUS trial

Sarah Saleem et al. BJOG. 2025 Jan.

Abstract

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.

Keywords: A‐PLUS trial; infection; low‐ and middle‐income countries; maternal antibiotics; pregnancy.

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Conflict of interest statement

Declaration of interest: The authors declare no conflicts of interest.

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