What additional antibiotic is recommended for nonelective cesarean sections to reduce the risk of endometritis?

For nonelective cesarean sections, the recommendation to use azithromycin as an additional antibiotic comes from its ability to enhance the coverage of potential pathogens, particularly in the context of preventing wound infections and endometritis. Azithromycin provides effective coverage against both gram-positive and some gram-negative organisms, as well as anaerobes, which are relevant in the setting of cesarean delivery.

In nonelective cesarean sections, there is a higher risk of infection compared to elective procedures, often due to prolonged labor, rupture of membranes, and other factors. Adding azithromycin has been shown to reduce the incidence of postoperative infections, including endometritis, by providing broader coverage against the diverse microbial flora that might be present in the lower genital tract and endometrial cavity.

In contrast to other antibiotics, while some may provide adequate coverage for specific organisms, azithromycin's broad-spectrum activity and favorable pharmacokinetics make it a key choice in this clinical setting. This has been supported by clinical guidelines that favor the use of combination antibiotics to maximize prophylactic efficacy in surgical settings, especially where infection risk is heightened.