{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T05:45:37Z","timestamp":1775713537847,"version":"3.50.1"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"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\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>A multi\u2010centre international trial (A\u2010PLUS), demonstrated that a single dose of 2\u2009g oral azithromycin in labour reduced the risk of maternal sepsis or death, but not neonatal mortality. We aimed to determine whether the efficacy of azithromycin in prevention of any maternal infection or neonatal infection varied by time interval from azithromycin administration to delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>This is a secondary analysis of a randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Multi\u2010centre international randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>Pregnant patients \u2265\u200928\u2009weeks gestation (singleton or multiple gestation) presenting in labour for planned vaginal delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>The primary outcome for this secondary analysis was maternal infection and the secondary outcome was any neonatal infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The estimated relative risks (and 95% confidence interval) of any maternal or neonatal infection comparing azithromycin to placebo were obtained by fitting a Poisson model adjusting for site, treatment arm, hours between drug administration and delivery (as continuous measure, and \u2264\u200912 or &gt;\u200912\u2009h for maternal and \u2264\u20099 or &gt;\u20099\u2009h for neonatal), and the two\u2010way interaction between treatment arm and hours between drug administration and delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Included in the analysis were\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914\u2009569 randomized to azithromycin and\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914\u2009667 to placebo. There was no evidence that the benefit of azithromycin on reducing the risk of any maternal infection varied by time from dose to delivery (RR 0.71 (0.64\u20130.79) and RR 0.71 (0.54\u20130.94) for \u2264\u200912 and &gt;\u200912\u2009h respectively, interaction\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.987), although there was an observed interaction in Sub\u2010Saharan Africa subgroup with reduced risk observed with administration &gt;\u200912 vs. \u2264\u200912 (RR 0.21 (0.08\u20130.54) vs. RR 0.52 (0.41\u20130.66), interaction\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03). There was no benefit observed in prevention of infant infection regardless of time from dose to delivery (\u2264\u20099 or &gt;\u20099\u2009h) (RR 1.00 (0.95\u20131.06) and RR 1.01 (0.88\u20131.15) interaction\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.997).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The benefit observed with a single intrapartum dose of azithromycin for prevention of any maternal infection in the setting of planned vaginal delivery was not observed to vary by time interval from azithromycin administration to delivery, although in some populations there may be greater benefit with delivery &gt;\u200912\u2009h from administration. Pregnant patients presenting for planned vaginal birth benefit from a single dose of 2\u2009g azithromycin regardless of how soon delivery is anticipated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.70121","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T08:30:15Z","timestamp":1767342615000},"page":"976-984","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Timing of Prophylactic Intrapartum Azithromycin Administration and Efficacy in Prevention of Maternal and Infant Infections: A Secondary Analysis of a Randomized Controlled Trial"],"prefix":"10.1111","volume":"133","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3705-6943","authenticated-orcid":false,"given":"Rupsa C.","family":"Boelig","sequence":"first","affiliation":[{"name":"Sidney Kimmel Medical College \u2010 Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2176-4697","authenticated-orcid":false,"given":"Avinash","family":"Kavi","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research  Belagavi Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet L.","family":"Moore","sequence":"additional","affiliation":[{"name":"RTI International  Research Triangle Park North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise C.","family":"Babineau","sequence":"additional","affiliation":[{"name":"RTI International  Research Triangle Park North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mrityunjay C.","family":"Metgud","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research  Belagavi Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manjunath S.","family":"Somannavar","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research  Belagavi Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivaprasad S.","family":"Goudar","sequence":"additional","affiliation":[{"name":"Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research  Belagavi Karnataka India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Derman","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College \u2010 Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiyam","family":"Sunder Tikmani","sequence":"additional","affiliation":[{"name":"Aga Khan University  Karachi Sindh 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of North Carolina School of Medicine  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Musaku","family":"Mwenechanya","sequence":"additional","affiliation":[{"name":"University Teaching Hospital  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elwyn","family":"Chomba","sequence":"additional","affiliation":[{"name":"University Teaching Hospital  Lusaka Zambia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manolo","family":"Mazariegos","sequence":"additional","affiliation":[{"name":"Instituto de Nutrici\u00f3n de Centro Am\u00e9rica y Panam\u00e1  Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lester","family":"Figueroa","sequence":"additional","affiliation":[{"name":"Instituto de Nutrici\u00f3n de Centro Am\u00e9rica y Panam\u00e1  Guatemala City Guatemala"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy 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