Trial reportBJOG : an international journal of obstetrics and gynaecology2025
Intrapartum and postpartum antibiotic use in seven low- and middle-income countries: Findings from the A-PLUS trial.
Trial report in BJOG : an international journal of obstetrics and gynaecology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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The trial behind it
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Who cites it
7 citing papers in PubMed.
- Non-study post-partum antibiotics use and risk of maternal and neonatal infection: A secondary analysis of the A-PLUS randomized controlled trial.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Trial
- The efficacy of a single dose of oral azithromycin in labour to prevent infections in infants and birthing parents in Fiji: secondary outcomes from a randomised controlled trial.BMJ global health · 2026Trial
- Antibiotic utilization in outpatient and inpatient hospitals in Zambia: a systematic review, key findings and public health implications.Infection prevention in practice · 2026Review
- Antibiotic Exposure Through Human Milk Influences the Infant Gut Microbiome.bioRxiv : the preprint server for biology · 2026Article
- Magnitude and the underlying reasons for routine prophylactic antibiotic use after uncomplicated vaginal births: A mixed-methods study in Eastern Uganda.BMJ public health · 2026Article
- Drawbacks of antibiotic regimen following cesarean deliveries on beneficial bacteria in colostrum, a prospective observational study.BMC nutrition · 2025Article
- Antibiotic use in infants in the 6 weeks after delivery in seven low- and middle-income countries: findings from the A-PLUS trial.Paediatrics and international child healthObservational
Corrections and comments
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Authors and funding
32 authors.
Funding
Abstract
objectiveTo 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.
designThe 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.
methodsWe 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 measuresNon-study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods.
resultsOf 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.
conclusionsAcross 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.
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