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While prophylactic intrapartum azithromycin reduces maternal mortality\/sepsis, it may promote antimicrobial resistance (AMR) in commensal bacteria,.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Randomly selected women and their infants participating in A-PLUS were enrolled in a longitudinal cross-sectional sub-study to assess the presence of azithromycin resistance in selected bacteria in nasal cultures.\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      and\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      were cultured on selective agar, then azithromycin-containing agar to select for azithromycin resistant bacteria, identified biochemically. Azithromycin susceptibility was assessed by E-test. Nasal cultures were collected from women and infants between August 11, 2021 and September 18, 2023 during labor\/day 1, day 7, 6 weeks, and 3, 6 and 12 months after delivery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study enrolled 911 women and 915 liveborn infants at 8 sites in 7 countries. Azithromycin resistance in\n                      <jats:italic>S aureus<\/jats:italic>\n                      was higher and azithromycin susceptibility was lower in women receiving azithromycin compared with those receiving placebo on day 7 (P\u2009&lt;\u20090.001), 6 weeks (P\u2009&lt;\u20090.001) and 3 months (P\u2009=\u20090.009) after delivery. Azithromycin resistance in\n                      <jats:italic>S aureus<\/jats:italic>\n                      was also higher and azithromycin susceptibility was lower 6 weeks after delivery (P\u2009&lt;\u20090.001) in infants born to women receiving azithromycin, Azithromycin resistance in\n                      <jats:italic>S. pneumoniae<\/jats:italic>\n                      was too sparse to interpret.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      There was an increase in prevalence of azithromycin resistance (or reduction in azithromycin susceptibility) in commensal nasal\n                      <jats:italic>S. aureus<\/jats:italic>\n                      between day 7, 6 weeks and 3 months in women exposed to azithromycin vs. placebo and only at 6 weeks in infants exposed to azithromycin vs. placebo. These differences between the azithromycin and placebo groups were no longer detected at 6 and 12 months post-partum in the women and after 6 weeks through 12 months in the infants.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0346174","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T17:38:47Z","timestamp":1776447527000},"page":"e0346174","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of prophylactic oral azithromycin during labor on Azithromycin Resistance (AMR) in nasal Staphylococcus aureus and Streptococcus pneumoniae in women and infants in the multi-country Azithromycin Prevention in Labor Use Study (A-PLUS)"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7455-8117","authenticated-orcid":true,"given":"Patricia 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