Cochrane Database Syst Rev

Antibiotics during labor may reduce maternal sepsis but show limited neonatal benefit

August 28, 2025

Study details: This Cochrane review synthesized data from four randomized trials involving 42,846 women in labor at ≥28 weeks’ gestation, all planning vaginal birth and without clinical indications for antibiotics. Participants received either a single oral dose of antibiotics (primarily azithromycin) or placebo. Three trials had low risk of bias; one had some concerns due to reporting bias.

Results: Antibiotic prophylaxis probably reduced maternal sepsis (1.2% vs. 1.8%; risk ratio [RR], 0.65; 95% confidence interval [CI], 0.56–0.77; moderate-certainty). However, it had little to no effect on:

• Maternal mortality: RR, 1.21; 95% CI, 0.63–2.33
• Neonatal sepsis: RR, 1.03; 95% CI, 0.96–1.10
• Neonatal mortality: RR, 1.03; 95% CI, 0.87–1.21
• NICU admission: RR, 1.03; 95% CI, 0.94–1.12
• Perineal wound infection: 1.0% vs. 1.5%; RR, 0.80; 95% CI, 0.64–0.99

Evidence on antimicrobial resistance was very uncertain, with transient increases in azithromycin-resistant bacteria in maternal samples.

Clinical impact: While prophylactic antibiotics during labor may reduce maternal sepsis, they offer no clear neonatal benefit and raise concerns about antimicrobial resistance. Use should be guided by local resistance patterns and stewardship principles.

Source:

Suzuki D, et al. (2025, August 26). Cochrane Database Syst Rev. Effects of antibiotic prophylaxis during labour on maternal and neonatal outcomes in women planning vaginal birth. https://pubmed.ncbi.nlm.nih.gov/40856178/