His team’s study, which included nearly 30,000 women across Africa, Asia, and Latin America was part of the A-PLUS trial. This trial focused on planned vaginal births, a context where maternal infections are often overlooked. The results were striking: women who received azithromycin were significantly less likely to develop infections compared with those given a placebo. This effect held true for different types of infections and locations, such as urinary, wound, uterine and breast infections.

Professor Carlo and his colleagues found that azithromycin reduced the number of infections by 25%. By preventing 1 in 4 infections, azithromycin could have a profound impact on global health. In areas with limited healthcare resources, preventing infections could save lives and reduce the burden on fragile medical systems.

Azithromycin is a well-known antibiotic, but its use during labour for planned vaginal delivery is new. The researchers noted a particularly significant reduction in serious infections such as sepsis when combined with other health measures.

One of the study’s strengths was its large scale. Encompassing multiple countries and diverse healthcare settings, it ensured the findings were broadly applicable, especially in low-resource settings where the stakes are highest.

The A-PLUS team has shone a spotlight on the disparity in maternal healthcare worldwide. In high-income countries, infections are often preventable with routine access to antibiotics and sterile environments. In regions where these resources are scarce, however, cost-effective solutions like a single-dose of azithromycin can bridge the gap.

Professor Carlo and his colleagues call for further research to optimize this approach, understand its full implications, and develop guidelines that ensure responsible antibiotic use.