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Introduction: The results of the Cesarean Section Optimal Antibiotic Prophylaxis(C/SOAP) trial describe an absolute reduction of 5.9 percentage points in the rate of the primary composite outcome of endometritis, wound infection, or other infection occurring within 6 weeks after non elective cesarean section with the use of adjuvant azithromycin prophylaxis. The absolute reduction in maternal postpartum use of antibiotics was 4.3 percentage points. The study drug was administered after the first incision in 12.4%of the patients who received azithromycin and in12.3% of those who received placebo. The authors did not indicate when the standard prophylaxis(mainly cefazolin) was delivered. Objective: The aim of our study is to evaluate the efficacy of addition of azithromycin to cefazolin pre-operative in reducing the risk of postoperative infection after elective CS. Methods: Four hundred patients were randomized to two groups. Control Group included 200 women undergoing elective CS. Patients received standard antibiotic prophylaxis cefazolin (at a dose of 1 gm) and azithromycin (at a dose of 1 gm) 2 hours preoperatively. Study Group included 200 women undergoing elective CS. Patients received only standard prophylaxis antibiotic (cefazolin). Results: Our study showed that majority of the mothers were housewives (70% in cefazolin-azithromycin group and 85.5% in cefazolin group), with a statistically high significant difference between the two groups regarding occupation (p<0.001). But, there was no statistically significant difference regarding residence (p>0.05) between both studied groups. Regarding demographic characteristics, majority of the mothers had similar mean age/years; 25.5 years in cefazolin-azithromycin group and 24.7 years in cefazolin group, with no statistically significant difference between both studied groups (p>0.05) but body mass index illustrated statistically a significant difference (p<0.05). On the other hand, preoperative hemoglobin showed no statistically significant difference between both studied groups (p>0.05). Regarding obstetric history, there were statistically significnat differences between both studied groups regarding parity and previous cesarean sections (p<0.05) and a high significant difference regarding previous abortions (p<0.001). Conclusion: At the end of this study, we observed that, with regards to postoperative fever, wound healing duration, infection post-surgery and per-vaginal discharge, addition of azithromycin to cefazolin (Zinol) is effective than cefazolin only in reducing the risk of postoperative infection after elective CS and maternal use of healthcare resources. [ABSTRACT FROM AUTHOR]