BACKGROUND AND PURPOSE:

• Islam et al. (BJOG, 2020) synthesized the evidence for the prevention of genital tract infection with the use of prophylactic antibiotics in women undergoing surgical procedures for incomplete abortion

METHODS:

• Systematic review and meta-analysis (through February 2020)
• Data sources
  • PubMed | Embase | Cochrane
• Inclusion criteria
  • RCTs
  • Trials that reported genital tract infections following surgical procedures for incomplete abortion
  • Compared antibiotic prophylaxis against placebo
• Data-analysis
  • Quality of evidence was assessed using GRADE criteria
• Primary Aim
  • Update evidence  on  the  efficacy of prophylactic  antibiotics  vs  placebo  for genital tract infections in women undergoing surgery for incomplete abortion in low, middle and high income countries

RESULTS:

• 16,178 women | 24 RCTs
• The risk of genital infection was significantly lower in the prophylactic antibiotics group (pooled estimate)
  • Relative risk (RR) 0.72 (95% CI, 0.58 to 0.90)
• The effect of antibiotics was insignificant in women from low and middle income countries
  • RR 0.90 (95% CI, 0.50 to 1.62)
  • 3 studies | 3,579 participants
  • Quality of evidence: Low due to heterogenous findings and bias
• Effect of antibiotics was clinically and statistically significant for women in high-income countries
  • RR 0.67 (95% CI, 0.53 to 0.84)
  • 21 studies | 12,599 participants
  • Quality of evidence: Strong
• Subgroup analyses
  • Results did not differ based on antibiotic or route of administration
  • Effect of prophylactic antibiotics as significantly higher for sharp curettage
    • Sharp curettage: RR 0.17 (95% CI, 0.07-0.42)
    • Blunt curettage: RR 0.70 (95% CI, 0.55-0.91)

CONCLUSION:

• Antibiotic prophylaxis appears to reduce the incidence of genital tract infection following surgical procedures for incomplete abortion in high income countries but not low and middle income countries
• The authors caution that the lack of apparent benefit in low and middle income countries

…should  be  interpreted  with  caution,  particularly  when applied to women in low and middle income countries, due to significant uncertainty associated with substantial heterogeneity between studies and variations in the trial protocols, such as inclusion and exclusion criteria, antibiotics used, doses, follow-up time, and prophylaxis starting time

Evidence in relation to women undergoing surgical procedure for incomplete abortion in high income  countries was assessed to be high and consistent

Learn More – Primary Sources:

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

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