Prophylactic antibiotics in first-trimester abortions: A clinical, controlled trial

Sonne‐Holm, Stig; Heisterberg, Lars; Hebjorn, S; Dyring-Andersen, Knud; Andersen, Jens T.; Hejl, Bo Løye

doi:10.1016/0002-9378(81)90488-9

Cited by 45 publications

(17 citation statements)

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“…Among women randomized to receive antibiotic prophylaxis in three RCTs [35,37,42], there was a lower incidence of PID at follow-up (4.8-5.5%) than for women assigned to the control group (8.6-10.9%). In two more recent ASC and hospital-based studies that provided universal prophylaxis [67] or only treated…”

Section: Accepted Manuscriptmentioning

confidence: 77%

“…Fourteen of the 23 studies reported ≥5.0% of cases later developed infections requiring outpatient antibiotics, although seven studies did not explicitly report outpatient treatment for non-hospitalized cases of endometritis and PID [36,37,[40][41][42]50,54]. Most studies in which ≥5.0% of women received outpatient treatment for infection noted that women were tested for Chlamydia prior to the procedure, and two provided antibiotic prophylaxis to those with positive results [39,46].…”

Section: Accepted Manuscriptmentioning

confidence: 98%

“…A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 9 Although the majority of studies reported on multiple interventions for minor and major complications, one study reported on every outcome considered in this review [20]; six studies only had information on treatment for infection [37,38,41,44,50,61] and two only reported on interventions for anesthesia-related complications [31,68]. The inclusion and exclusion criteria were clearly defined, but several studies reported excluding women who tested positive for a sexually transmitted infection or recently had been treated with antibiotics.…”

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

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Complications from first-trimester aspiration abortion: a systematic review of the literature

2015

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Section: Accepted Manuscriptmentioning

confidence: 77%

Section: Accepted Manuscriptmentioning

confidence: 98%

Section: Risk Of Bias In Included Studiesmentioning

confidence: 99%

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Complications from first-trimester aspiration abortion: a systematic review of the literature

2015

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“…Although the lack of significance may be explained by the small size of the study population, a therapeutic gain of 5.3% does not warrant antibiotic treatment of all women undergoing induced abortion. A few randomized controlled studies have shown significant reductions in the frequency of postabortal PID associated with prophylactic antibiotic treatment (Sonne‐Holm et al . 1981; Levallois & Rioux 1988; Darj et al .…”

Section: Discussionmentioning

confidence: 99%

A double‐blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion

Sørensen¹,

Thranov²,

Hoff³

et al. 1992

BJOG

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Objective To assess the prophylactic use of erythromycin in prevention of post‐abortal pelvic inflammation disease (PID) in first trimester abortion. Design Double‐blind, randomized controlled trial. Setting Department of Surgery, County Hospital, Denmark. Subjects Four hundred and thirty two women who were to undergo induced abortion before 12 weeks gestation were randomized to be treated either with prophylactic erythromycin or a placebo. Intervention The women were randomized to receive a placebo or erythromycin, 500 mg twice a day for 71/2 days starting the evening before the abortion. All the women were investigated for Chlamydia trachomatis and Neisseria gonorrhoea before the abortion. Main outcome measures Frequency of cervical C. trachomatis and N. gonorrhoea and frequency of PID after abortion. Results Fifty four women were excluded after randomization. The frequency of PID was 11% (20/189) in the erythromycin group and 16% (30/189) in the placebo group (P= 0.13, χ2‐test). The prevalence of C. trachomatis was 19% (15/78) in women ≤ 20 years of age, 13% (14/109) in women between 21 and 25 years and 2% (5/241) in women ≤ 26 years of age. In women positive for C. trachomatis erythromycin prophylaxis significantly reduced the frequency of PID to 8% (l/13) compared with 43% (6/14) in the placebo group (P= 0.051, logistic regression analysis). Erythromycin had no effect on other potential high risk groups (first pregnancy, nulliparous, <20 years of age, and women with previous PID). Conclusion Prophylactic erythromycin is not warranted for all women having an abortion. Cervical C. trachomatis is a risk factor for postabortal PID, and prophylaxis with erythromycin significantly reduces the frequency of PID. However, only a few women with PID had cervical C. trachomatis, and the prevention of post‐abortal PID remains a major challenge requiring further studies.

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“…The identification of women who have an increased risk of suffering PID after legal abortion is not a simple matter. In our study the women were allocated to the high risk group if they gave any history of previous PID or sexually transmitted disease, as recommended by Sonne‐Holm et al (1981).…”

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Authors' Reply

Meller¹

1995

BJOG

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is therefore much welcomed. However, we do not feel that it answers the question; more specifically, it does not allow them to draw the conclusion that the use of the prophylaxis described should be extended to all women undergoing elective termination of pregnancy in the first trimester.Women were allocated to the high risk group if they gave any history suggestive of PID or sexually transmitted disease. Whilst these factors attempt to identify a group at increased risk of developing post-abortal PID by way of their risk of having a sexually transmitted disease, we feel it is neither specific enough nor appropriate. Although the authors failed to screen all subjects for sexually transmitted diseases, they did so in more than 50% of patients, who were presumably still subject to the same selection criteria. Their figures show that in the screened population the incidence of chlamydia, a major aetiological agent of post-abortal PID, in the low risk group was twice that in the high risk group. Additionally, there were two cases of gonorrhoea in the former but none in the latter. These figures would suggest that their criteria used to define risk were unsound.It is established that the risk factors for the acquisition of chlamydia include: a short duration of present relationship, a lack of condom use and the age of the woman, with higher risk being linked to the ages of 18 to 25 years (Fish et al. AUTHORS' REPLY Sir,The reported incidence of postabortal PID is variable. In comparison with previous reports, the incidence of postabortal PID in our study was low. The overall incidence of PID was 2.8 ? ' a and in women who were not treated with antibiotics, the low risk control group, the incidence was 3.6%. The identification of women who have an increased risk of suffering PID after legal abortion is not a simple matter. In our study the women were allocated to the high risk group if they gave any history of previous PID or sexually transmitted disease, as recommended by Sonne-Holm et al. (1981).By this procedure, however, we did not intend to identify women with an increased risk of having a sexually transmitted disease as indicated by Wilkinson and Hamilton-Fairley. Whilst having a sexually transmitted disease undoubtedly is a risk factor for postabortal PID, our data indicate that it is not the only risk factor. In 32 women, a sexually transmitted microbial agent was found (i.e., Chlamydia trachomatis or Neisseria gonorrhoea but PID was diagnosed in only two of these women (6.3 YO). Twenty women with PID were negative for C. trachomatis and N . gonorrhoea. The incidence of postabortal PID in both our low risk groups was decreased, compared with our high risk groups.More specifically, the incidence of PID in the low risk control group without prophylactic treatment was not elevated compared with the two high risk groups, in both of which the women were treated with prophylactic antibiotics and the incidence in the low risk ceftriaxone group was significantly lower than the incidence in the high risk groups (i.e.,...

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Prophylactic antibiotics in first-trimester abortions: A clinical, controlled trial

Cited by 45 publications

References 14 publications

Complications from first-trimester aspiration abortion: a systematic review of the literature

Complications from first-trimester aspiration abortion: a systematic review of the literature

A double‐blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion

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