Does Antibiotic Prophylaxis Reduce the Risk of Infection Following Surgical Procedures for Incomplete Miscarriage?
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
Systematic review and meta-analysis (through February 2020)
PubMed | Embase | Cochrane
Trials that reported genital tract infections following surgical procedures for incomplete abortion
Compared antibiotic prophylaxis against placebo
Quality of evidence was assessed using GRADE criteria
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
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
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)
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
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan