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

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.