Use of prophylactic azithromycin in sepsis in obstetrics: systematic review
DOI:
https://doi.org/10.55892/jrg.v7i15.1326Keywords:
Azithromycin, Women, Prophylaxis, Obstetrics, SepsisAbstract
Sepsis is a systemic inflammatory response syndrome (SIRS), triggered by a suspected or confirmed infection. Clinically, it ranges from an infection to severe organic dysfunction. In obstetrics, sepsis is one of the main causes of maternal death, along with hemorrhagic and hypertensive diseases. Furthermore, its occurrence is linked to an increase in infection and fetal mortality. Therefore, the use of azithromycin (AZT) has been increasingly considered intrapartum, as it can provide protection against bacteria that cause maternal infections and prevent serious postpartum complications. This work aims to evaluate the use of AZT as prophylaxis for sepsis in obstetrics. The platforms PUBMED, SCIELO, LILACS, COCHRANE LIBRARY and EMBASE were used as bases. In total, 20 articles were found, of which 13 were excluded after reading the title and abstract. During the complete reading of the others, 2 were eliminated due to exclusion criteria and thus, only 5 articles were included in this review. Of these, 44,643 women were evaluated and it was observed that those who used AZT, in general, had a lower incidence of infections and those who, in addition to using AZT, had a vaginal birth, had a reduced risk for sepsis and maternal death. As for newborns who received AZT, there was a reduction in infections, but there wasn't any reduction in the risk of sepsis or mortality. It is therefore inferred that the use of AZT in obstetrics provides a lower rate of maternal complications during and after birth, as well as guaranteeing a safer postpartum period and reducing infectious conditions in newborns.Downloads
References
Brasil. Ministério da Saúde. Secretaria de Atenção Primária à Saúde. Departamento de Ações Programáticas. Manual de gestação de alto risco. Ministério da Saúde, Brasília: Ministério da Saúde, 2022.
Castro, EO; Bortolotto, MRFL; Zugaib, M. Sepse e choque séptico na gestação: manejo clínico. Revista Brasileira de Ginecologia e Obstetrícia, 2008; 30:631-8.
Cordioli RL, Cordioli E, Negrini R et al. Sepse e gravidez: sabemos tratar?. Revista Brasileira de Terapia Intensiva, 2013; 25: 334-44.
Edgar, M. (2005). Ciência com consciência / Edgar Morin; tradução de Maria D. Alexandre e Maria Alice Sampaio Dória - Ed. revista - 8a ed. - Rio de Janeiro: Bertrand Brasil, 2005. 350 p.
Fritzen, JS; Colet, CF; Oliveira, KR. Uso de antimicrobianos por gestantes no serviço público de saúde. Revista Brasileira em Promoção da Saúde, 2014; 27:198-206.
Laurine, JPF. Sepse na gestação: descrição dos métodos diagnósticos e terapêuticos em hospital referência da maior cidade do interior da Bahia. Trabalho de Conclusão de Curso (Medicina), Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, 2022.
Lima, APS; Nangino, GO; Soares, FFR et al. Classificação de risco e tempo porta-antibiótico no paciente com suspeita de sepse. Revista Latino-Americano de Enfermagem, 2023; 31: e4066.
Matos, KLA; Morais, LO; Cavalcante, CC et al. Sepse durante o período gestacional. Eletronic Journal Collection Health, 2019; 11:1-6.
Mendes, K. D. S., Silveira, R. C. C. P. & Galvão, C. M. Revisão Integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto - Enfermagem, 2008; 17: 758-764.
Moura, JM; Silva, LM; Souza, RF et al. Indicação e uso de azitromicina no tratamento do COVID-19: revisão de literatura. Brazilian Journal of Development, 2021; 7:56547-56556.
Roca, A; Camara, B; Bognini, JD et al. Effect of intrapartum azithromycin vs placebo on neonatal sepsis and death: a randomized clinical trial. JAMA, 2023; 329: 716-724
Sanusi, A; Ye, Y; Boggess, K et al. Timing of adjunctive atithromycin for unscheduled cesarean delivery and postdelivery infection. Obstetrics & Gynecology, 2022; 139:1043-1049.
Siqueira-Batista R, Gomes AP, Calixto-Lima L et al. Sepse: atualidades e perspectivas. Revista Brasileira de Terapia Intensiva, 2011; 23: 207-16.
Souza, M. T., Silva, M. D. & Carvalho, R. Revisão integrativa: o que é e como fazer. Einstein, 2010; 8: 102-106.
Souza, LB; Mendes, ET. Sepse materna: aspecto clínico-epidemiológicos e prognósticos - Hospital da PUC-Campinas entre 2014-2020. The Brazilian Journal of Infectious Diseases, 2022; 26: e102441.
Subramaniam, A; Waites, KB; Jauk, VC et al. Azithromycin-based extended-spectrum antibiotic prophylaxis for cesarean: role of placental colonization with genital ureaplasmas and mycoplasmas. American Journal of Perinatology, 2019; 36:1002-1008.
Subramaniam, A; Ye, Y; Mbah R et al. Single dose of oral azithromycin with or without amoxicillin to prevent peripartum infection in laboring, high-risk women in cameroon: a randomized controlled trial. Obstetrics & Gynecology, 2021; 138:703-713.
Tita, ATN; Carlo, WA; McClure, EM et al. Azithromycin to prevent sepsis or death in women planning a vaginal birth. The New England Journal of Medicine, 2023; 388: 1161-1170.
Zastrow, JB; Brittes, KU; Mizobuchi, LS et al. Sepse em gestantes atendidas em um Hospital público de Curitiba - PR. Revista da Sociedade Brasileira de Clínica Médica, 2018; 16: 208-211.
Westphal, GA; Feijó, J; Andrade, PS et al. Estratégia de detecção precoce e redução de mortalidade na sepse grave. Revista Brasileira de Terapia Intensiva, 2009; 21: 113-123.
