Saleem Sarah, Yasmin Haleema, Moore Janet L, Rahim Anum, Shakeel Iram, Lokangaka Adrien, Tshefu Antoinette, Bauserman Melissa, Mwenechanya Musaku, Chomba Elwyn, Goudar Shivaprasad S, Kavi Avinash, Derman Richard J, Krebs Nancy F, Figueroa Lester, Mazariegos Manolo, Nyongesa Paul, Bucher Sherri, Esamai Fabian, Patel Archana, Waikar Manjushree, Shivkumar Poonam, Hibberd Patricia L, Petri William A, Billah Sk Masum, Haque Rashidul, Carlo Waldemar A, Tita Alan, Koso-Thomas Marion, Hemingway-Foday Jennifer, McClure Elizabeth M, Goldenberg Robert L
Aga Khan University, Karachi, Pakistan.
Jinnah Postgraduate Medical Centre, Karachi, Pakistan.
BJOG. 2025 Jan;132(1):72-80. doi: 10.1111/1471-0528.17930. Epub 2024 Aug 14.
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.
The antibiotic use sub-study was a planned prospective, observational sub-study of the A-PLUS trial.
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.
Totally, 29 278 pregnant women enrolled in the A-PLUS trial.
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.
Non-study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods.
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.
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.
描述在低收入和中等收入国家（LMICs）进行的双盲美国国立儿童健康与人类发展研究所全球网络阿奇霉素分娩期应用（A-PLUS）试验中，非研究性抗生素在分娩期和产后的使用情况。
抗生素使用子研究是A-PLUS试验一项计划中的前瞻性观察性子研究。
该研究在七个国家的八个全球妇女和儿童健康研究网络（全球网络）站点附属的医院或健康中心进行，这些国家包括：孟加拉国、巴基斯坦、印度（两个站点）、肯尼亚、赞比亚、刚果民主共和国（DRC）和危地马拉。
共有29278名孕妇参与了A-PLUS试验。
我们收集了29278名因分娩入住医疗机构的孕妇总体及三个时间段内非研究性抗生素使用的数据，这三个时间段分别为：（1）分娩前在医疗机构内；（2）分娩后至出院；（3）出院后至产后42天。
总体及三个时间段内各站点非研究性抗生素的使用情况，以及用于治疗或预防的情况。
在该研究的29278名女性中，5020名（17.1%；95%可信区间16.7%-17.6%）在分娩前在医疗机构接受了非研究性抗生素治疗，11956名（40.8%；95%可信区间40.3%-41.4%）在分娩后在医疗机构接受了非研究性抗生素治疗，13390名（47.6%；95%可信区间47.0%-48.2%）女性在分娩后及出院后接受了非研究性抗生素治疗。亚洲和危地马拉站点的女性比非洲站点的女性更常被开具抗生素。在这三个时间段内，接受抗生素治疗的患者中，预防性用药的比例分别为82.3%、97.7%和90.7%。不同时间段和站点使用的抗生素类型差异很大，但总体而言，青霉素类药物、头孢菌素类药物和甲硝唑的使用频率高于其他类型。
在全球网络的八个站点中，分娩前在医疗机构内以及出院前后的产后阶段，抗生素使用频繁，但各站点和时间段的使用情况差异很大。
