Comparison Study of Cefazolin Versus Cefazolin Plus Azithromycin Prophylaxis in Post-Cesarean Endometritis
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Purpose
Despite the generalized use of preoperative antibiotic prophylaxis, endometritis remains as the most frequent post-cesarean delivery complication. This increased morbidity translates into extended post-partum antibiotic use and prolongation of hospital stay with the subsequent increase in health care expenses. The current regimen recommended by the American College of Obstetricians and Gynecologists for cesarean delivery prophylaxis (1st generation cephalosporins) does not cover for Ureaplasma Urealyticum, a microorganism that has been associated with an increased risk of endometritis in post-cesarean section patients. Azithromycin, an antibiotic that has both aerobic and some anaerobic coverage, uniquely covers Ureaplasma and would be an excellent second antibiotic for cesarean section chemoprophylaxis. Our hypothesis is that the addition of azithromycin to standard chemoprophylaxis with cefazolin can effect a 25% reduction of post-cesarean section endometritis.
| Condition | Intervention | Phase |
|---|---|---|
|
Endometritis |
Drug: Azithromycin Drug: Cefazolin |
Phase 4 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Double Blind (Subject, Investigator) Primary Purpose: Prevention |
| Official Title: | A Randomized Clinical Trial of Cefazolin Versus Cefazolin Plus Azithromycin Prophylaxis in Post-Cesarean Endometritis |
- Development of post cesarean endometritis [ Time Frame: 3-4 days while in hospital during post partum period ] [ Designated as safety issue: No ]
- Hospital stay length [ Time Frame: 3-4 days while in hospital during post partum period ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 506 |
| Study Start Date: | November 2012 |
| Estimated Study Completion Date: | November 2014 |
| Estimated Primary Completion Date: | November 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Cefazolin
single antibiotic
|
Drug: Cefazolin |
|
Active Comparator: Cefazolin + Azitrhromycin
double antibiotic
|
Drug: Azithromycin Drug: Cefazolin |
Eligibility| Genders Eligible for Study: | Female |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Pregnant patients between 37 and 42 weeks gestational weeks.
- Pregnant patients undergoing indicated cesarean section at Truman Medical Center Hospital July 2012 and July 2014.
- Pregnant patient that received prenatal care at Truman Medical Center. Hospital Hill, Samuel Rogers or Swope Parkway health centers at least 1 month prior to the Cesarean delivery.
- Signed informed consent.
Exclusion Criteria:
- Allergy to cephalosporins or azithromycin.
- Refusal to sign consent form.
- Clinical signs of chorioamnionitis: fever 100.4 F or higher, uterine tenderness, maternal or fetal tachycardia.
- Immunocompromised condition: HIV positive with CD4 count below 200, chronic steroid use, pregestational diabetes, cancer, chemotherapy.
- Need for emergent cesarean precluding consent or availability of study medication.
- Need for hysterectomy at cesarean section.
- Use of antibiotic in the 72 hours prior to admission.
Contacts and Locations| Contact: Gerard Malnar, MD | 816-404-5150 | gerard.malnar@tmcmed.org |
| Contact: Pedro Morales, MD | 816-352-3278 | moralesramirezp@umkc.edu |
| United States, Missouri | |
| Truman Medical Center - Hospital Hill | Recruiting |
| Kansas City, Missouri, United States, 64108 | |
| Principal Investigator: Pedro Morales, MD | |
| Principal Investigator: Gerard Malnar, MD | |
| Sub-Investigator: Katherine Goodpasture, DO | |
| Principal Investigator: | Pedro Morales, MD | University of Missouri, Kansas City |
| Principal Investigator: | Gerard Malnar, MD | Truman Medical Center |
| Principal Investigator: | Katherine Goodpasture, DO | University of Missouri, Kansas City |
More Information
No publications provided
| Responsible Party: | Gerard Malnar, MD, University of Missouri, Kansas City |
| ClinicalTrials.gov Identifier: | NCT01721616 History of Changes |
| Other Study ID Numbers: | 12-13 |
| Study First Received: | November 1, 2012 |
| Last Updated: | April 8, 2013 |
| Health Authority: | United States: Institutional Review Board |
Additional relevant MeSH terms:
|
Pelvic Inflammatory Disease Endometritis Adnexal Diseases Genital Diseases, Female Uterine Diseases Cefazolin |
Azithromycin Anti-Bacterial Agents Anti-Infective Agents Therapeutic Uses Pharmacologic Actions |
ClinicalTrials.gov processed this record on June 18, 2013