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  • Title: Preventive lymecycline therapy in women with a history of pelvic inflammatory disease undergoing first-trimester abortion: a clinical, controlled trial.
    Author: Heisterberg L, Gnarpe H.
    Journal: Eur J Obstet Gynecol Reprod Biol; 1988 Jul; 28(3):241-7. PubMed ID: 3061846.
    Abstract:
    In a clinical, controlled trial 55 women with a history of pelvic inflammatory disease (PID) undergoing first-trimester abortion were randomized to either lymecycline therapy or placebo. Twenty-four women received lymecycline capsules 300 mg b.i.d. for 14 days starting on the morning of the abortion and 31 received similar placebo medication. In the lymecycline group 2 women (8.3%) and in the placebo group 7 (22.6%) contracted postabortal PID, a non-significant difference (p greater than 0.2). The variables age, gestational age, number of spontaneous abortions, births and episodes of PID, and Hegar size were not associated with the rate of postabortal PID. Women without previous induced abortions had a significantly increased rate of postabortal infection (p = 0.02), but the treatment did not influence this rate. Three women had a positive culture for Chlamydia trachomatis at the time of abortion and two of these had postabortal PID. None of 7 women with postabortal PID had significant increases in IgA, IgG or IgM chlamydia antibody titers, but two women with uncomplicated abortions had serological evidence of infection. The number of hospital days and amounts of antibiotics prescribed to women with postabortal PID were not significantly different between the two treatment groups (p greater than 0.05). Women with a history of PID had an elevated risk of postabortal PID warranting the use of some sort of prophylaxis, and screening for C. trachomatis in an abortion population is recommended. To assess the efficacy of prophylactic antibiotics on postabortal infection in women with a history of pelvic inflammatory diseases (PID), 55 such women undergoing 1st-trimester pregnancy termination were randomly assigned to receive either lymecycline therapy or placebo. Chlamydial antibodies were investigated in all women before and after the abortion. 24 women received 300 mg lymecycline capsules for 14 days, starting on the morning of the abortion procedure; the remaining 31 women received placebo medication on the same schedule. Postabortal PID occurred in 2 women (8.3%) in the lymecycline group and 7 women (22.6%) in the placebo group--a nonsignificant difference. Age, gestational age, number of spontaneous abortions, births, previous episodes of PID, Hegar size, and the presence of C trachomatis did not influence the rate of postabortal PID. Although women with no previous abortions had a significantly higher rate of infection, this rate was not influenced by the preabortion treatment mode. C trachomatis was identified in 3 of 53 women for whom cultures were obtained; 2 of these women contracted postabortal PID. None of the 7 women with postabortal PID had significant increases in IgA, IgG, or IgM chlamydia antibody titers, although 2 women with uncomplicated abortions had serologic evidence of infection. Use of lymecycline did not significantly reduce the number of hospital days or amounts of antibiotics required among women with postabortal PID. Overall, the high rate of postabortal PID recorded in this study among women with a history of PID (23%) supports the use of some sort of prophylactic method. Since these women do not seem to harbor chlamydial infection more often than women without previous PID, penicillin or ampicillin may be effective.
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