The antibiotic azithromycin reduced low birth weight and prematurity in Africa and Asia but didn’t lower infant deaths, infections or hospital admissions, a research review1 has found.

In a systematic review and meta-analysis, researchers led by the Murdoch Children’s Research Institute (MCRI) reviewed 14 studies undertaken in African and Asian countries, involving 17,594 participants.

This review found that there was uncertainty about the potential benefits of this intervention on neonatal deaths, admissions and infections, and potential harmful effects on stillbirth despite biological reasons why this intervention may have benefits for these outcomes. Therefore, results from studies like ours underway in Fiji will help to better understand the effect of this intervention on these outcomes,

said MCRI researcher Dr. Maeve Hume-Nixon.

Inexpensive Antibiotic

Azithromycin is an inexpensive broad-spectrum macrolide antibiotic widely used to treat chest and ear infections2. In pregnancy it has been specifically used in the past to treat sexually transmitted infections and, alongside other antimalarial drugs, to prevent adverse consequences of malaria on maternal and fetal outcomes and cesarean wound infections.

MCRI Professor Fiona Russell said the large clinical trials in Africa and Asia, along with the MCRI-led trial in Fiji, were likely to inform global policy related to maternal child health and hopefully benefit infants and mothers around the world.

The Bulabula MaPei study in Fiji is a randomized controlled clinical trial testing if azithromycin given to women in labor, prevents maternal and infant infections.

Administration of azithromycin during labor may be a cheap and simple intervention that could be used to improve neonatal death rates in low and-middle-income countries, alongside strengthening of maternal child health services. This study, together with other large clinical trials, will add to evidence for the consideration of new international maternal and child health guidelines,

Russell said.

Globally, infections cause about 21 per cent of 2.4 million neonatal deaths each year and 52 per cent of all under five deaths, with a disproportionate amount occurring in low- and middle-income countries.


  1. Maeve Hume-Nixon et al. A Systematic Review and meta-analysis of the effect of administration of azithromycin during pregnancy on perinatal and neonatal outcomes. EClinicalMedicine (2021). Vol 40, 101123 ↩︎

  2. McMullan BJ Mostaghim M. Prescribing azithromycin. Australian Prescriber. 2015; 38: 87-89 ↩︎


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