An editorial discusses from a US perspective, whether azithromycin should now be recommended as a routine adjunct to cefazolin for prophylaxis of infectious complications in caesarean deliveries. It suggests that on the basis of this well-designed, pragmatic, multicentre trial, it seems likely that a single adjunctive 500-mg dose of intravenous azithromycin would reduce a number of infectious complications for some women without established infections who are undergoing nonelective cesarean section.