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RecruitingNCT06605118PRECEDEUpdated Apr 9, 2026

Azithromycin Prophylaxis for PRElabor CEsarean DElivery Trial

A Phase 3 interventional study of Azithromycin Injection and Placebo in Obstetrical Complications, Labor and Delivery Complication and Cesarean Delivery, sponsored by The George Washington University Biostatistics Center. Recruiting at 14 sites in United States. Open to female participants, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-04-09.

Sponsored by The George Washington University Biostatistics Center · Phase 3, Interventional, and Prevention

From the registry’s dates

  • Started Nov 2024; still recruiting 2 years later.

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Phase
Phase 3
Study type
Interventional
Enrollment
8,000
Allocation
Randomized
Sex
Female
01

Study summary

This is a phase-III multi-center double-blind randomized controlled trial of 8,000 individuals undergoing a scheduled or prelabor cesarean delivery who are randomized to either adjunctive azithromycin prophylaxis or to placebo. Both groups also will receive standard of care preoperative antibiotics (excluding azithromycin). The primary endpoint is a maternal infection composite defined as any one of the following up to 6 weeks postpartum: endometritis, wound infection, abscess, septic thrombosis, sepsis, pneumonia, pyelonephritis and breast infection.

Read the detailed description

This is a phase-III multi-center double-blind randomized controlled trial of 8,000 individuals undergoing a scheduled or prelabor cesarean delivery who are randomized to either azithromycin prophylaxis or to placebo. All participants will receive standard of care preoperative antibiotics. The primary objective is to evaluate in patients undergoing scheduled/prelabor cesarean if pre-incision adjunctive azithromycin prophylaxis reduces the risk of post-cesarean infections compared with placebo. Secondary objectives include 1) to assess the perinatal and maternal safety of pre-incision adjunctive azithromycin, 2) to evaluate whether adjunctive azithromycin prophylaxis reduces maternal and neonatal resource use outcomes compared with placebo, and 3) to evaluate whether adjunctive azithromycin influences maternal and neonatal infection with resistant organisms compared with placebo.

Individuals will be randomized prior to the start of the cesarean to either 500mg of intravenous azithromycin or to placebo (normal saline). Maternal blood and cord blood will be collected on a subset of the population. Research staff will abstract maternal and neonatal outcomes following delivery and discharge from the hospital. A single maternal follow-up study visit at 6 weeks (4-8 weeks) postpartum will be scheduled to ascertain maternal and neonatal outcomes.

02

Conditions studied

  • Obstetrical Complications
  • Labor and Delivery Complication
  • Cesarean Delivery

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Keywords

  • cesarean delivery
  • infection
  • maternal morbidity
  • antibiotics
  • prevention
03

In context

Infections

2,094 studies on the registry are indexed under Infections; 364 are open to participants now.

This study's planned enrollment of 8,000 is above the median of 113 across 1,304 interventional studies indexed under Infections.

Browse Infections studies →

Lead sponsor

The George Washington University Biostatistics Center is the lead sponsor of 25 studies on the registry; 3 are open to participants now.

Of its 6 completed or terminated interventional studies of FDA-regulated products, 6 (100%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
Child (0–17), Adult (18–64), Older adult (65+)
Sexes eligible
Female
Accepts healthy volunteers
Yes

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • ≥ 23 weeks' gestation (ACOG dating criteria)
  • Scheduled or prelabor cesarean delivery
  • Singleton or twin gestation

Exclusion criteria

Exclusion Criteria:

  • Allergy or to azithromycin or macrolide antibiotics, including those with a history of cholestatic jaundice/hepatic dysfunction associated with prior use of azithromycin
  • Chorioamnionitis
  • Bacterial infection (e.g., pyelonephritis) requiring ongoing antibiotic treatment after delivery
  • Premature rupture of membranes (PROM) or labor (i.e., contractions with ongoing cervical change)
  • Fetal demise or known major congenital anomaly
  • Azithromycin treatment within 7 days
  • Planned use of antimicrobial prophylaxis after delivery for any reason
  • Known structural heart disease or active cardiomyopathy (current \<40%)
  • Known arrhythmia with or taking scheduled medications known to prolong the QT interval such that it would preclude the use of azithromycin
  • Refusal or unable to obtain consent (e.g., language barrier)
  • Participating in another intervention study that influences the primary outcome in this study
  • Participation in this trial in a previous pregnancy. Patients who were screened in a previous pregnancy, but not randomized, do not have to be excluded.
Terms in these criteria, in plain language(3)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Contraindication

A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.

LVEF (left ventricular ejection fraction)

The share of blood the heart’s main pumping chamber (the left ventricle) pushes out with each beat, measured by an echocardiogram (heart ultrasound) or a MUGA scan. About 50–70% is normal.

QT and QTc

On an ECG, the QT interval is the time the heart’s lower chambers take to activate electrically and recover in each beat. QTc is that time adjusted for heart rate (QTcF by Fridericia’s formula, QTcB by Bazett’s). Some medicines lengthen it, and a long QTc can raise the risk of a dangerous heart rhythm.

The study may name a correction formula and a limit in milliseconds, often around 450–480.

05

Study design

Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Quadruple (Participant, Care provider, Investigator, Outcomes assessor)
Enrollment
8,000 participants (estimated)

Study arms

  • Experimental
    Azithromycin prophylaxis and standard of care preoperative antibiotics

    500mg of intravenous azithromycin administered up to 1 hour prior to cesarean incision (or as soon as feasible after incision) and infused over one hour per FDA infusion recommendations for azithromycin. Additionally patients will received standard of care preoperative antibiotics (excluding azithromycin) prior to incision.

    Drug: Azithromycin Injection · Drug: Standard of Care Preoperative antibiotics

  • Placebo comparator
    Placebo and standard of care preoperative antibiotics

    Normal saline administered up to 1 hour prior to cesarean incision (or as soon as feasible after incision) and infused over one hour in addition to standard of care preoperative antibiotics (excluding azithromycin) prior to incision.

    Drug: Placebo · Drug: Standard of Care Preoperative antibiotics

Interventions

  • 500mg azithromycin in 250 mL of normal saline

  • DrugPlacebo

    250 mL of normal saline

  • DrugStandard of Care Preoperative antibiotics

    standard of care preoperative antibiotics (excluding azithromycin) prior to incision

06

What researchers measure

Primary outcomes

  1. Maternal infection composite

    a maternal infection composite defined as any one of the following: endometritis, wound infection, abdominal or pelvic abscess, septic pelvic thrombosis, sepsis, pneumonia, pyelonephritis and breast infection

    Time frame: Delivery up to 6 weeks postpartum (a period of up to 6 weeks)

Secondary outcomes

  1. Non-infections wound complications

    any of the following wound complications without diagnosis of a wound infection: seroma, wound breakdown, erythema and/or hematoma

    Time frame: Delivery up to 6 weeks postpartum (a period of up to 6 weeks)

  2. Perinatal composite outcome

    Any of the following: * Neonatal death occurring within 28 days of birth or prior to initial discharge from hospital * Respiratory distress syndrome * Necrotizing enterocolitis grade 2 or higher * Periventricular leucomalacia * Intraventricular hemorrhage grades 3 or 4 * Bronchopulmonary dysplasia grade 3 or higher * Suspected sepsis * Confirmed sepsis * Cardiac resuscitation * Severe neonatal drug reaction defined as anaphylaxis or any other reported severe event suspected to be due to azithromycin * Hypertrophic pyloric stenosis defined as physician diagnosis supported by surgical intervention (pyloromyotomy) or pathology evaluation through 6 weeks from birth.

    Time frame: hospital discharge, 6 weeks of birth, or death (whichever occurs first)

  3. Number of neonates with Allergic Reaction

    Neonatal allergic reaction (e.g., skin rash) through discharge or 7 days from birth, whichever is earliest, suspected to be due to study medication.

    Time frame: birth through hospital discharge, or 7 days from birth, whichever is earliest

  4. Number of Neonates with Gastrointestinal Symptoms

    vomiting, diarrhea, feeding difficulty through discharge or 7 days from birth, whichever is earliest

    Time frame: birth through hospital discharge, or 7 days from birth, whichever is earliest

  5. Number of Maternal Deaths

    Death

    Time frame: From randomization through 6 weeks postpartum (a period of up to 6 weeks)

  6. Maternal Resource Composite

    * Hospital readmission * Emergency room (ER) visit * Unscheduled clinic visits

    Time frame: From hospital discharge following delivery through 6 weeks postpartum (a period of up to 6 weeks)

  7. Neonatal Resource Composite

    * Hospital readmission * Emergency Room (ER) visit

    Time frame: From hospital discharge following delivery through 6 weeks postpartum (a period of up to 6 weeks)

  8. Maternal Hospital Length of Stay

    Length of hospital stay in days

    Time frame: Hospital admission to hospital discharge (up to 42 days)

  9. Rate of Neonatal ICU Admission

    Number of neonates admitted to NICU

    Time frame: Delivery to hospital discharge (up to 120 days)

  10. Number of Participants with Maternal Resistant Infection

    bacteria and resistance patterns from clinical cultures

    Time frame: Randomization through 6 weeks postpartum (a period of up to 6 weeks)

  11. Number of Neonates with Neonatal Resistant Infection

    bacteria and resistance patterns from clinical cultures

    Time frame: From birth up to 6 weeks of age

07

Study locations

14 of 14 sites recruiting
08

References and documents

Individual participant data

Plan to share: Yes — Data will be shared via NICHD DASH in accordance with NIH policy.

Supporting information: Study protocol, Informed consent form

No publications or documents are linked to this record.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Started Nov 2024 (actual). Primary completion is estimated for Nov 2027, 36 months after the start.

Of 75 phase 3 interventional studies under Infections, half reached primary completion within 30 months of starting (the median), counting those still running; a quarter within 17 and three quarters within 53. This study's planned 36 months is above that.

Infections covers many different conditions, not one, so the studies compared here vary widely. Read these figures as a rough guide.

How these figures are worked out, and which studies are left out of them.

Registered
Sep 13, 2024
First posted
Sep 20, 2024
StartActual
Nov 6, 2024
Primary completionEst.
Nov 30, 2027
CompletionEst.
Nov 30, 2027
Last update
Apr 9, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Apr 9, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT06605118
Lead sponsor
The George Washington University Biostatistics Center
Responsible party
Sponsor
First posted
Sep 20, 2024
Start date
Nov 6, 2024
Primary completion
Nov 30, 2027 (estimated)
Completion
Nov 30, 2027 (estimated)
Last update
Apr 9, 2026

Study contacts

Rebecca G Clifton, PhD
Contact
rclifton@bsc.gwu.edu
301-881-9260
Steven Weiner, MS
Contact
weiner@bsc.gwu.edu
Alan T.N. Tita, MD PhD
study chair · University of Alabama at Birmingham
Kim Boggess, MD
study chair · University of North Carolina, Chapel Hill
Monica Longo, MD PhD
study director · Eunice Kennedy Shriver NICHD
Rebecca G Clifton, PhD
principal investigator · The George Washington University Biostatistics Center

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Azithromycin

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