Introduction: There has been a significant rise in cesarean section rates worldwide over the past two decades. Currently, cesarean section is responsible for almost 21% of all births, which is equivalent to nearly one birth out of every five women. A cesarean section is one of the most common surgical procedures that is associated with occurrence of surgical site infections. The purpose of this research is to study whether addition of azithromycin to standard antibiotic prophylaxis before skin incision would decrease the incidence of surgical site infection after cesarean section. Material and methods: The present study was conducted in the Department of Obstetrics and Gynecology, KLES Dr Prabhakar Kore Hospital and MRC, Belagavi from January 2023 to January 2024. Pregnant women at gestational age of 28 weeks or more, who are to undergo emergency cesarean delivery who have given informed consent, were recruited. Group A received the standard antibiotic prophylactic drug-injection, ceftriaxone 1 gm IV. Group B received the standard antibiotic prophylactic drug injection ceftriaxone 1 gm IV along with injection azithromycin 500 mg IV (given within 60 minutes prior to incision). The primary outcome of surgical site infection was studied and compared between two groups. Results: The incidence of surgical site infection in the control group was 35.9%. In the intervention group, the incidence was significantly less, i.e. 13.2% (p-value 0.001). Surgical site infections are categorized as superficial, deep, or organ space. In group A, there were 48 superficial infections (85.7%) and 8 deep infections (14.3%). There were 5 superficial infections (71.4%) and 2 deep infections (28.6%) in group B. In this study, mean postoperative stay was 5.72 days with a standard deviation of 1.617 in group A and 5.31 days with a standard deviation of 1.176 in group B. The mean postoperative stay was slightly shorter in group B, suggesting a potential benefit of azithromycin in reducing hospital stay duration. The proportion of readmissions was higher in group A, suggesting a potential benefit of azithromycin in reducing readmissions. Conclusion: In this randomized controlled trial conducted at our hospital involving 256 participants over a span of 1 year, it was concluded that adjunctive azithromycin administration decreases postoperative infectious morbidity in emergency cesarean deliveries when administered within 60 minutes prior to skin incision.