{
    "abstract": "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.\nThe antibiotic use sub-study was a planned prospective, observational sub-study of the A-PLUS trial.\nThe 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.\nTotally, 29\u2009278 pregnant women enrolled in the A-PLUS trial.\nWe collected data on 29\u2009278 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\u2009days post-partum.\nNon-study antibiotic use overall and for treatment or prophylaxis by the site during the three time periods.\nOf the 29\u2009278 women in the study, 5020 (17.1%; 95% CI 16.7%-17.6%) received non-study antibiotics in the facility prior to delivery, 11\u2009956 (40.8%; 95% CI 40.3%-41.4%) received non-study antibiotics in the facility after delivery, and 13\u2009390 (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.\nAcross 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.",
    "authors": [
        {
            "affiliation": "Aga Khan University, Karachi, Pakistan.",
            "firstname": "Sarah",
            "initials": "S",
            "lastname": "Saleem"
        },
        {
            "affiliation": "Jinnah Postgraduate Medical Centre, Karachi, Pakistan.",
            "firstname": "Haleema",
            "initials": "H",
            "lastname": "Yasmin"
        },
        {
            "affiliation": "RTI International, Durham, North Carolina, USA.",
            "firstname": "Janet L",
            "initials": "JL",
            "lastname": "Moore"
        },
        {
            "affiliation": "Aga Khan University, Karachi, Pakistan.",
            "firstname": "Anum",
            "initials": "A",
            "lastname": "Rahim"
        },
        {
            "affiliation": "Aga Khan University, Karachi, Pakistan.",
            "firstname": "Iram",
            "initials": "I",
            "lastname": "Shakeel"
        },
        {
            "affiliation": "Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.",
            "firstname": "Adrien",
            "initials": "A",
            "lastname": "Lokangaka"
        },
        {
            "affiliation": "Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo.",
            "firstname": "Antoinette",
            "initials": "A",
            "lastname": "Tshefu"
        },
        {
            "affiliation": "University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.",
            "firstname": "Melissa",
            "initials": "M",
            "lastname": "Bauserman"
        },
        {
            "affiliation": "University of Zambia University Teaching Hospital, Lusaka, Zambia.",
            "firstname": "Musaku",
            "initials": "M",
            "lastname": "Mwenechanya"
        },
        {
            "affiliation": "University of Zambia University Teaching Hospital, Lusaka, Zambia.",
            "firstname": "Elwyn",
            "initials": "E",
            "lastname": "Chomba"
        },
        {
            "affiliation": "KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India.",
            "firstname": "Shivaprasad S",
            "initials": "SS",
            "lastname": "Goudar"
        },
        {
            "affiliation": "KLE Academy Higher Education and Research, J N Medical College Belagavi, Belagavi, Karnataka, India.",
            "firstname": "Avinash",
            "initials": "A",
            "lastname": "Kavi"
        },
        {
            "affiliation": "Thomas Jefferson University, Philadelphia, Pennsylvania, USA.",
            "firstname": "Richard J",
            "initials": "RJ",
            "lastname": "Derman"
        },
        {
            "affiliation": "University of Colorado School of Medicine, Denver, Colorado, USA.",
            "firstname": "Nancy F",
            "initials": "NF",
            "lastname": "Krebs"
        },
        {
            "affiliation": "Instituto de Nutrici\u00f3n de Centroam\u00e9rica y Panam\u00e1, Guatemala City, Guatemala.",
            "firstname": "Lester",
            "initials": "L",
            "lastname": "Figueroa"
        },
        {
            "affiliation": "Instituto de Nutrici\u00f3n de Centroam\u00e9rica y Panam\u00e1, Guatemala City, Guatemala.",
            "firstname": "Manolo",
            "initials": "M",
            "lastname": "Mazariegos"
        },
        {
            "affiliation": "Moi University School of Medicine, Eldoret, Kenya.",
            "firstname": "Paul",
            "initials": "P",
            "lastname": "Nyongesa"
        },
        {
            "affiliation": "Indiana School of Medicine, University of Indiana, Indianapolis, Indiana, USA.",
            "firstname": "Sherri",
            "initials": "S",
            "lastname": "Bucher"
        },
        {
            "affiliation": "Moi University School of Medicine, Eldoret, Kenya.",
            "firstname": "Fabian",
            "initials": "F",
            "lastname": "Esamai"
        },
        {
            "affiliation": "Lata Medical Research Foundation, Nagpur, India.\nDatta Meghe Institute of Higher Education and Research, Sawangi, India.",
            "firstname": "Archana",
            "initials": "A",
            "lastname": "Patel"
        },
        {
            "affiliation": "Government Medical College, Nagpur, India.",
            "firstname": "Manjushree",
            "initials": "M",
            "lastname": "Waikar"
        },
        {
            "affiliation": "Mahatma Gandhi Institute of Medical Sciences, Wardha, India.",
            "firstname": "Poonam",
            "initials": "P",
            "lastname": "Shivkumar"
        },
        {
            "affiliation": "Boston University School of Public Health, Boston, Massachusetts, USA.",
            "firstname": "Patricia L",
            "initials": "PL",
            "lastname": "Hibberd"
        },
        {
            "affiliation": "University of Virginia, Charlottesville, Virginia, USA.",
            "firstname": "William A",
            "initials": "WA",
            "lastname": "Petri"
        },
        {
            "affiliation": "International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh.\nUniversity of Sydney, Sydney, New South Wales, Australia.",
            "firstname": "Sk Masum",
            "initials": "SM",
            "lastname": "Billah"
        },
        {
            "affiliation": "International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh.",
            "firstname": "Rashidul",
            "initials": "R",
            "lastname": "Haque"
        },
        {
            "affiliation": "University of Alabama at Birmingham, Birmingham, Alabama, USA.",
            "firstname": "Waldemar A",
            "initials": "WA",
            "lastname": "Carlo"
        },
        {
            "affiliation": "University of Alabama at Birmingham, Birmingham, Alabama, USA.",
            "firstname": "Alan",
            "initials": "A",
            "lastname": "Tita"
        },
        {
            "affiliation": "Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.",
            "firstname": "Marion",
            "initials": "M",
            "lastname": "Koso-Thomas"
        },
        {
            "affiliation": "RTI International, Durham, North Carolina, USA.",
            "firstname": "Jennifer",
            "initials": "J",
            "lastname": "Hemingway-Foday"
        },
        {
            "affiliation": "RTI International, Durham, North Carolina, USA.",
            "firstname": "Elizabeth M",
            "initials": "EM",
            "lastname": "McClure"
        },
        {
            "affiliation": "Columbia University School of Medicine, New York, New York, USA.",
            "firstname": "Robert L",
            "initials": "RL",
            "lastname": "Goldenberg"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2024 John Wiley & Sons Ltd.",
    "doi": "10.1111/1471-0528.17930\n10.1016/S0140-6736(19)30773-1\n10.1016/j.idc.2023.07.002\n10.3390/antibiotics12101557\n10.1186/s12978-020-01020-8",
    "journal": "BJOG : an international journal of obstetrics and gynaecology",
    "keywords": [
        "A\u2010PLUS trial",
        "infection",
        "low\u2010 and middle\u2010income countries",
        "maternal antibiotics",
        "pregnancy"
    ],
    "methods": null,
    "publication_date": "2024-08-14",
    "pubmed_id": "39140197\n29472491\n26598777\n28658587\n30134425\n33608872\n24118809\n21514558\n33427692\n19300334\n18771992\n18165392\n33068866\n26255208\n37530593\n31097213\n22295115\n18294334\n24754708\n36681812\n29581252\n25848538\n34439054\n28808578\n37735012\n37887258\n26429594\n35856134\n36320077\n38351649\n36808424\n36048776\n33256769\n37648383\n36757318\n27026482\n28130432\n27682034\n34541478\n37691261\n27080992",
    "results": "Of the 29\u2009278 women in the study, 5020 (17.1%; 95% CI 16.7%-17.6%) received non-study antibiotics in the facility prior to delivery, 11\u2009956 (40.8%; 95% CI 40.3%-41.4%) received non-study antibiotics in the facility after delivery, and 13\u2009390 (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.",
    "title": "Intrapartum and postpartum antibiotic use in seven low- and middle-income countries: Findings from the A-PLUS trial.",
    "xml": "<Element 'PubmedArticle' at 0x788504760f40>"
}