{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:40:45Z","timestamp":1784684445131,"version":"3.55.0"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T00:00:00Z","timestamp":1723593600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe the intrapartum and postpartum use of non\u2010study antibiotics in low\u2010 and middle\u2010income countries (LMICs) during the double\u2010blinded NICHD Global Network Azithromycin in Labor (A\u2010PLUS) trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>The antibiotic use sub\u2010study was a planned prospective, observational sub\u2010study of the A\u2010PLUS trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Settings<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Totally, 29\u2009278 pregnant women enrolled in the A\u2010PLUS trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We collected data on 29\u2009278 pregnant women admitted to a facility for delivery related to non\u2010study 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\u2009days post\u2010partum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Non\u2010study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 29\u2009278 women in the study, 5020 (17.1%; 95% CI 16.7%\u201317.6%) received non\u2010study antibiotics in the facility prior to delivery, 11\u2009956 (40.8%; 95% CI 40.3%\u201341.4%) received non\u2010study antibiotics in the facility after delivery, and 13\u2009390 (47.6%; 95% CI 47.0%\u201348.2%) women received non\u2010study 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\u2010periods, 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\u2010period and site, but generally, penicillin\u2010type drugs, cephalosporin\u2010type drugs and metronidazole were used more frequently than other types.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Across the eight sites of the Global Network, in the facility before delivery, and in the post\u2010partum periods before and after facility discharge, antibiotics were used frequently, but use was highly variable by site and time\u2010period.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17930","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T05:19:21Z","timestamp":1723612761000},"page":"72-80","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Intrapartum and postpartum antibiotic use in seven low\u2010 and middle\u2010income countries: Findings from the A\u2010PLUS 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