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Title: Prophylactic antibiotics for curettage abortion.
Author: Grimes DA, Schulz KF, Cates W.
Journal: Am J Obstet Gynecol; 1984 Nov 15; 150(6):689-94. PubMed ID: 6388334.
Abstract:
Opinion is divided as to the advisability of routine use of prophylactic antibiotics for curettage abortion. Six studies, including three randomized clinical trials, suggest that prophylaxis reduces infectious morbidity associated with curettage abortions by about one half. Three other studies, two involving prophylaxis for instillation abortions and one involving a vaginal antiseptic for curettage abortion, support the hypothesis that antimicrobial prophylaxis reduces morbidity. Tetracyclines are commonly used for this purpose. The cost of routine prophylaxis even with an expensive tetracycline would appear to be offset by the savings in direct and indirect costs. Prophylaxis may help prevent both short-term morbidity and potential late sequelae, such as ectopic pregnancy and infertility. Evidence concerning prophylaxis for abortion patients is examined, choice of a prophylaxis regimen is discussed, and the economic impact of routine prophylaxis for curettage abortions ins the US is estimated. 8 studies have been conducted to evaluate the efficacy of systemic prophylactic antibiotics for abortion patients: 4 randomized clinical trials and 4 cohort studies. 6 studies included only women undergoing suction curettage abortion at less than 12 weeks' gestation; 2 studies investigated instillation abortions performed later in pregnancy. 1 report described use of a vaginal antiseptic rather than a systemic antibiotic. To allow comparisons between studies, the date contained in each were reanalyzed and are expressed in terms of relative risks with 95% confidence intervals. The relative risk is a ratio, i.e., the morbidity rate for the antibiotic-treated group divided by the morbidity rate for the nontreated group. Randomized clinical trials are the preferred means of evaluating new drug therapies. The 4 trials summarized in a table all show a reduction in morbidity associated with prophylaxis, but these studies have methodologic shortcomings, including low power (i.e., a low likelihood of detecting a difference between treatments if one exists) and exclusion of patients from analysis after randomization, which can lead to biased and invalid results. Despite methodologic limitations, these studies, taken as a whole, support the hypothesis that systemic prophylactic antibiotics are effective in lowering morbidity from currettage abortions by about one half. The consistency of this finding with different drugs, different outcome measures of morbidity, different types of abortion, and different populations lends credibility to the effectiveness of prophylaxis. The studies suggest that administration of a prophylactic antibiotic reduces febrile morbidity after abortion, regardless of the drug used, the dose given, or the time of administration in relation to the abortion. When selecting an antibiotic regimen, ideally, prophylactic antibiotics for women undergoing curettage abortion should provide therapeutic endometrial tissue levls of the drug used, be effective against common uterine pathogens, and be active at the time of operation. Among the drugs available for prophylactic use, tetracycline appears to be the most commonly used in the US. Prophylaxis should usually be stopped within 24 hours. Among the tetracyclines the short-acting drugs have the advantage of low cost but the disadvantage of requiring 4 doses over 24 hours, which may decrease compliance compared with less frequent administration. The cost of routine prophylaxis even with an expensive tetracycline appears to be offset by the savings in direct and indirect costs. Prophylaxis may help prevent both shortterm morbidity and potential late sequalae.

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