Which antibiotic for prophylaxis at vacuum aspiration for miscarriage?
Thank you to Drs. Praditpan and Davis for a great article. I think, however, there is more evidence for azithromycin 1 g PO (than doxycycline as the authors recommend) as prophylaxis for surgical abortion and no antibiotic prophylaxis for medi‑ cal abortion.
Tirun (Ty) Gopal, MD San Francisco, California
Drs. Praditpan and Davis respond
Thank you for your comment and for allowing us to provide clarification on the topic of antibiotic prophylaxis at the time of vacuum aspiration for miscarriage management. Few studies address the question of antibiotic prophylaxis at the time of surgical management of miscarriage, and a meta-analysis found insufficient data to yield a conclusion.1 Recommendations for infection prophylaxis in miscarriage management have been extrapolated from the abundance of data for induced abortion, since the surgical procedure is the same for both.
The 2011 Society of Family Planning (SFP) clinical guidelines on prevention of infection after induced abortion identified 14 randomized trials that examined the efficacy of antibiotic regimens administered preoperatively to prevent upper genital tract infection after first trimester surgical procedures.2 Five studies (involving a total of 5,380 patients) examined tetracyclines, while only 1 study (N = 378) examined macrolides. The trials comparing tetracycline prophylaxis with placebo showed significant risk reduction in upper genital tract infection in tetracycline users (up to 88%), with an overall postinfection rate similar to that reported in the United States (<1%). Regardless of antibiotic choice or duration, the risk of infection was lower in women who received any prophylactic antibiotics compared with women who received placebo.
Based on these data and doxycycline’s cost effectiveness and its minimal adverse effects, the SFP recommends doxycycline as the antibiotic of choice for prevention of infection after induced abortion. Antibiotics should be administered on the day of the procedure and, if clinicians prefer, for no more than 3 days afterwards. Azithromycin is a macrolide that can be used for presumptive treatment of chlamydia at the time of surgical abortion.3 No trials compare azithromycin to doxycycline for prevention of infection after vacuum aspiration.
- May W, Gulmezoglu AM, Ba-Thike K. Antibiotics for incomplete abortion. Cochrane Database Syst Rev. 2007;(4):CD001779.
- Achilles SL, Reeve MF; Society of Family Planning. Prevention of infection after induced abortion: release date October 2010: SFP Guideline 2010. Contraception. 2011;83(4):295–309.
- Royal College of Obstetricians and Gynaecologists. The care of women requesting induced abortion: Evidence-based clinical guideline number 7. https://www.rcog.org.uk/globalassets/doc uments/guidelines/abortion-guideline_web_1.pdf. Published November 2011. Accessed December 18, 2015.
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