Preventive lymecycline therapy in women with a history of pelvic inflammatory disease undergoing first-trimester abortion: a clinical, controlled trial

Heisterberg, Lars; Gnarpe, Håkan

doi:10.1016/0028-2243(88)90034-2

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…Our definition, based on the prescription of antibiotics for symptoms may overestimate the incidence of infection but it takes into account the fact that most cases are managed in primary care without access to blood tests or laparoscopy. Even in trials using strict case definitions the incidence of post‐abortal infection has been found to vary from 5% 18 to 23% 19 . Differences in the efficacy of the antibiotic regimen might also have contributed to the difference in effect size.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial

Crowley

Low

Turner

et al. 2001

BJOG

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Objective To determine the prevalence of bacterial vaginosis in women undergoing ®rst trimester suction termination of pregnancy and to evaluate the ef®cacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis.Design Randomised double-blind placebo-controlled trial. Setting Two teaching hospitals and one district general hospital.Sample Two hundred and seventy-three women with bacterial vaginosis undergoing termination of pregnancy.Methods Women with bacterial vaginosis, diagnosed using modi®ed Spiegel's criteria, were individually randomised to receive either a 2 g metronidazole suppository or identical placebo per-operatively. Participants, doctors and investigators were blinded to treatment allocation. Participants were asked to complete a questionnaire about post-operative symptoms, visits to the general practitioner, antibiotic treatment, readmission to hospital, contraception and emotional response after one month. Results The prevalence of bacterial vaginosis was 29.3% (326/1111). Intention-to-treat analysis showed that post-operative upper genital tract infection developed in 12/142 (8.5%) women allocated to metronidazole and 21/131 (16.0%) women randomised to placebo, a difference of 7.6% (95% con®dence intervals ±15.4 to 10.2%; relative risk 0.53, 0.27 to 1.03, P 0.055). The effect of prophylaxis was similar when the analysis was restricted to women receiving the allocated treatment and with complete follow up. There was no difference in the risk of readmission to hospital and the frequencies of self reported symptoms in the two groups were similar.Conclusion This randomised placebo-controlled trial among women with bacterial vaginosis provides weak evidence that metronidazole decreases the risk of upper genital tract infection after ®rst trimester suction termination of pregnancy but a chance ®nding could not con®dently be excluded. Large well-conducted randomised trials with long term outcome measures are now needed to determine the most effective antibiotic combinations and strategy for prevention of post-abortal pelvic infection.

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Section: Discussionmentioning

confidence: 99%

Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial

Crowley

Low

Turner

et al. 2001

BJOG

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“…The detailed characteristics of the included studies are presented in Table S1. Among the 24 studies, seven studies were conducted in Sweden, 30‐36 seven in Denmark, 11,37‐42 five in USA, 7,10,43‐45 one each from UK, 46 Canada, 47 Zimbabwe 4 and Thailand, 8 and another combined study including data from Pakistan, Tanzania and Uganda 9 . Year of publication ranged from 1975 to 2019.…”

Section: Resultsmentioning

confidence: 99%

Prophylactic antibiotics for preventing genital tract infection in women undergoing surgical procedures for incomplete abortion: a systematic review and meta‐analysis of randomised controlled trials

Islam

Furuya‐Kanamori

Mahmood

et al. 2021

BJOG

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Background Findings about the effect of prophylactic antibiotics in preventing genital tract infection (GTI) associated with surgical procedures used for incomplete abortions are conflicting. Some reported a decrease in infection associated with the use of antibiotic prophylaxis, whereas others found no significant reduction in GTI. Objective To synthesise systematically the evidence on the effect of prophylactic antibiotics compared with placebo in women undergoing surgical procedures for incomplete abortion. Search strategy In February 2020, PubMed, Embase and Cochrane Central for Register of Controlled Trials were searched for relevant published randomised controlled trials. Selection criteria Randomised controlled trials reporting GTI following surgical procedures for incomplete abortion and comparing antibiotic prophylaxis with placebo. Data collection and analysis Meta‐analysis using inverse variance heterogeneity model included subgroup and sensitivity analyses determined a priori were conducted. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Main results A total of 16 178 women who participated in 24 eligible randomised controlled trials published between 1975 and 2019 were included. Pooled estimates showed the risk of GTI following surgical procedures after incomplete abortion was significantly lower among those who had prophylactic antibiotics (relative risk [RR] = 0.72; 95% CI 0.58–0.90; I2 = 49%). There was no significant effect of antibiotics in women in low‐ and middle‐income countries (three studies, 3579 participants, RR = 0.90; 95% CI 0.50–1.62; I2 = 63%), but it was clinically and statistically significant among women high‐income countries (21 studies, 12 599 participants, RR = 0.67; 95% CI 0.53–0.84; I2 = 44%), with a strong level of evidence as assessed by GRADE. Conclusion This study provides evidence that antibiotic prophylaxis is beneficial in reducing post‐abortion GTI among women undergoing surgical procedures for incomplete abortion. More studies are needed from low‐ and middle‐income countries. Tweetable abstract Prophylactic antibiotics after incomplete abortion are effective in reducing GTI. More studies are needed from low‐ and middle‐income countries.

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“…Eight randomized trials on antibiotic prophylaxis for first‐trimester suction curettage and 1 randomized trial involving second‐trimesterdilation and evacuation were identified [11–19]. No trials of dilation and curettage without products of conception met the inclusion criteria.…”

Section: Resultsmentioning

confidence: 99%

“…Five studies investigated tetracycline use [11–15]. In the 3 placebo‐controlled studies, the definitions of infection were similar and based on physical examination findings, including lower abdominal pain, tenderness, purulent leukorrhea or vaginal bleeding, leukocytosis, and fever [11–13]. Postoperative follow‐up was 2–5 weeks across the studies.…”

Section: Resultsmentioning

confidence: 99%

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Antibiotic prophylaxis for selected gynecologic surgeries

Morrill

Schimpf

Abed

et al. 2012

Intl J Gynecology & Obste

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Preventive lymecycline therapy in women with a history of pelvic inflammatory disease undergoing first-trimester abortion: a clinical, controlled trial

Cited by 9 publications

References 11 publications

Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial

Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial

Prophylactic antibiotics for preventing genital tract infection in women undergoing surgical procedures for incomplete abortion: a systematic review and meta‐analysis of randomised controlled trials

Antibiotic prophylaxis for selected gynecologic surgeries

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