Guidelines for antibiotic prophylaxis in gynecology. A prospective randomised study of the effects of prophylactic antibiotics on the incidence of bacteraemia following hysteroscopic surgery. Use of a Prophylactic Antibiotic in Elective Major Gynologic Operations Antibiotic prophylaxis for hysteroscopy evaluation of the uterine cavity. Evidence on antibiotic prophylaxis for cesarean section alone is not sufficient to change the practices of doctors in a teaching hospital. Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial Gynaecologic surgery from uncertainty to science: evidence-based surgery is no passing fad. Prophylactic antibiotics for suction curettage abortion: results of a clinical controlled trial. Randomized study of antibiotic prophylaxis for general and gynaecological surgery from a single centre in rural Africa Our patients do not need endocarditis prophylaxis for genitourinary tract procedures: insights from the 2007 American Heart Association guidelines. Short course of prophylactic antibiotics in laparoscopically assisted vaginal hysterectomy. A randomised comparison of strategies for reducing infective complications of induced abortion Prophylactic Antibiotics for Suction Curettage in Incomplete Abortion Antibiotic prophylaxis in abdominal hysterectomy, with special reference to the duration of the prophylaxis Outcomes from use of an evidence-based practice guideline. A Multicenter, Double-Blind, Randomized, Placebo-Controlled Study to Assess Whether Antibiotic Administration Should Be Recommended During Office Operative Hysteroscopy Postcesarean endometritis: a brief review and comparison of three antibiotic regimens.
Using a r and om table of numbers , 100 premenopausal women undergoing vaginal hysterectomy were assigned to a short-term or long-term antibiotic prophylaxis regimen . The short-term regimen patients received a total of 3 Gm . of cephaloridine in divided doses on the day of operation , while the long-term regimen patients also received oral cephalexin postoperatively . The preoperative profiles of the two study groups were similar , and the postoperative results were not significantly different . A quantitative evaluation of aerobic and anaerobic bacteria recovered from the surface of the vagina was done , and  cephaloridine content of vaginal washings , serum , and vaginal tissue was determined . This information was utilized to suggest guidelines for antibiotic prophylaxis in gynecology OBJECTIVE To study the effect of prophylactic antibiotics on the incidence of bacteraemia following hysteroscopic surgery . DESIGN Prospect i ve r and omized study . SETTING Aberdeen Royal Infirmary . SUBJECTS One hundred and sixteen women about to undergo either endometrial laser ablation ( ELA ) or transcervical resection of the endometrium ( TCRE ) . INTERVENTION Fifty-five women were r and omised to receive 1.2 g of Augmentin ( co-amoxiclav ) i.v . at induction of anaesthesia . Sixty-one women received no antibiotic prophylaxis .  Blood cultures were obtained at the end of the surgical procedure . RESULTS Incidence of bacteraemia in the non-antibiotic group ( 16 % ) was significantly higher than that in the antibiotic group ( 2 % ) ( 95 % confidence interval for difference from 5 % to 25 % ) . The majority of organisms were of dubious clinical significance and contamination could not be excluded in 7 cases out of 10 . CONCLUSION There is no convincing evidence that antibiotics are of value in this clinical setting The use of a prophylactic antibiotic in elective gynologic operations was evaluated in a prospect i ve , double-blind , controlled study . Morbidity in those patients undergoing abdominal hysterectomy was 41 % in the placebo group , and 14.1 % in the drug group . In patients undergoing vaginal hysterectomy morbidity was 50 % in the control group and 4.1 % in the drug group . More experienced surgeons had the same rate of morbidity as inexperienced ones . Hospital stay was significantly reduced for abdominal and vaginal hysterectomy patients treated with the drug OBJECTIVE To assess the prevalence of infectious complications and the protective effect of  prophylactic antibiotic treatment  after diagnostic office hysteroscopy in asymptomatic , infertile patients with normal results from transvaginal sonography . DESIGN Recording of infectious complications after routine hysteroscopy in the context of a r and omized controlled trial ; pseudor and omized , center-specific application of antibiotic prophylaxis . SETTING Two tertiary infertility care units . PATIENT(S ) Six hundred thirty-one unselected , asymptomatic , infertile women who underwent routine , diagnostic hysteroscopy prior to a first in vitro fertilization ( IVF ) or intracytoplasmic sperm injection treatment .  INTERVENTION(S ) Depending on the hospital and according to local protocol s , hysteroscopy was performed with or without antibiotic prophylaxis . MAIN OUTCOME MEASURE(S ) The prevalence of infectious complications after routine hysteroscopy .  RESULT ( S ) Of the 631 women who underwent routine , diagnostic hysteroscopy ,  antibiotic prophylaxis  was prescribed to 266 women , whereas 365 women underwent the procedure without prophylaxis . Only one infectious complication occurred ( 0.4 % ) in a patient who had not undergone therapeutic interventions and had taken antibiotic prophylaxis . This complication was successfully treated with antibiotics on an outpatient basis . CONCLUSION ( S ) Considering the extremely low risk of infectious complications and the lack of evidence , suggesting a beneficial effect of antibiotic prophylaxis , its use for routine , diagnostic office hysteroscopy should not be recommended AIMS To assess the pattern of prophylactic antibiotic use in cesarean sections , identify factors associated with single-dose prescriptions as evidence -based best practice , and evaluate the changes in use of single-dose compared with multiple-dose regimens and the variation of use between doctors after dissemination of evidence . METHODS An analytical descriptive study was conducted . The medical records of 432 women undergoing cesarean section from April to September 2001 after dissemination of evidence in a teaching hospital in Southern Thail and were review ed . Use of single-dose prophylactic antibiotic was the main outcome measure . Patterns of  prophylactic antibiotics  , and factors associated with pregnant women and doctors , were analyzed and compared with baseline data among 463 women undergoing cesarean section in 1998 . Multivariate logistic regression with r and om effects was used for analysis . RESULTS After the dissemination of evidence , the rate of single-dose prescriptions increased from 14.2 to 22.4 % ( P < 0.01 ) , single-dose prescriptions decreased for patients who had experienced longer duration s of ruptured membranes , and the timing of the administration of antibiotics improved , but multiple-dose and duration of postoperative prescriptions increased . The variation in prescribing antibiotics between doctors was significant ( P < 0.001 ) . CONCLUSIONS Knowledge of evidence alone does not improve practice s uniformly . Consequently , other interventions are necessary to improve practice Objective To determine the prevalence of bacterial vaginosis in women undergoing first trimester suction termination of pregnancy and to evaluate the efficacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis BACKGROUND The r and omized controlled trial ( RCT ) is the least biased measure of the effectiveness of interventions , including surgical interventions . The aim was to review the available evidence base in gynaecologic surgery , to assess what progress has been made and to determine gaps in the evidence for clinical decision-making . METHODS Systematic review s involving gynaecological surgery interventions were extracted from the Cochrane Data base of Systematic Review s ( Issue 2 , 2007 ) and data were extracted for key primary outcomes from each of the r and omized trials in the review s. The review s were categorized as to whether they had provided evidence of effectiveness for pre-defined outcomes of most relevance to patients . RESULTS Of 371 review s or protocol s published on the Cochrane Data base of Systematic Review s ( Issue 2 , 2007 ) , only 30 were completed review s assessing surgical interventions . Seven review s concluded there was evidence of a significant effect ( whether beneficial or harmful ) of the interventions studied for pre-defined primary outcomes ; 11 review s concluded there was some evidence of significant effects for primary outcomes along with some gaps for primary outcomes ; 12 review s concluded insufficient evidence of effectiveness . Common themes of unique method ological challenges and pitfalls with trials of surgical interventions were apparent . CONCLUSIONS Cochrane review s have gone a long way to establishing a sound evidence base in gynaecologic surgery : some gaps in the evidence have been eliminated and others highlighted . In general , gynaecology has been a specialty where surgical interventions have been well exposed to the scrutiny of RCTs compared with other surgical specialties The prophylactic use of 300 mg doxycycline at the time of an abortion was evaluated in a r and omized controlled trial . In the group with negative chlamydia screening results , only two ( 0.4 % ) of 502 patients who received prophylactic treatment developed pelvic infection , compared with 15 ( 3.0 % ) of 497 patients who received placebos ( p = 0.001 ) . The same effectiveness was found in women with positive chlamydia screening results .  Vomiting was the major side effect of the medication and could limit its use . A simulation of selective prophylaxis in women with negative chlamydia screening results showed that its selective use in patients with a history of gonorrhea or in nulliparous women with multiple sex partners could be nearly two thirds as effective as general prophylaxis In a district rural hospital in Ug and a , 850 surgical patients were evaluated prospect ively over a 3‐year period to compare the clinical efficacy of conventional postoperative penicillin therapy with single‐dose ampicillin prophylaxis for hernia repair and ectopic pregnancy , and with single‐dose ampicillin‐metronidazole prophylaxis for hysterectomy and caesarean section . The high rate of postoperative infection usually encountered in African hospitals after conventional treatment with penicillin for 7 days was significantly reduced with the new regimen : from 7·5 to 0 per cent in hernia repair and from 10·7 to 2·4 per cent in ectopic pregnancy ; from 20·0 to 3·4 per cent in hysterectomy and from 38·2 to 15·2 per cent in caesarean section . Length of hospital stay and postoperative mortality rates were also significantly reduced . Single‐dose ampicillin  prophylaxis with or  without metronidazole  , although rarely used in developing countries , is more cost effective than st and ard penicillin treatment The 2007 American Heart Association guidelines for the prevention of infective endocarditis have dramatically reduced both the types of eligible procedures and the types of eligible cardiac lesions that require prophylaxis . Antibiotic prophylaxis to prevent infective endocarditis is not indicated for any patient undergoing obstetric and /or gynaecological procedures , not even for patients with underlying cardiac lesions with the highest risk of developing complications from endocarditis . This sharp departure from previously published guidelines relies on the recognition that endocarditis is more likely to develop from " r and omly occurring " bacteremia ( e.g. , from brushing teeth ) than from invasive procedures and that antibiotic prophylaxis has not been proven to be effective . A short discussion on enterococcal infections associated to obstetric and gynaecological procedures and therapeutic implication s is presented OBJECTIVE To evaluate whether a short course of prophylactic antibiotics is as efficacious as a longer course in laparoscopically assisted vaginal hysterectomy ( LAVH ) . STUDY DESIGN A total of 156 patients who underwent LAVH were included in the study ; 82 received a long course of combined prophylactic antibiotics  , and 74 received a short course , administered for < 24 hours during the perioperative period . The subjects were r and omly assigned using a computer-generated schedule . Data regarding re source consumption were collected from the hospital 's electronic data base . Patient characteristics and medical care process data were collected from the patient charts . Student 's t test was used to determine the statistical significance of the differences between continuous variables in the 2 groups of patients . The chi2 test was used to measure the statistical significance of differences between nominal variables in the 2 groups . RESULTS The short course significantly influenced the number of injected vials of antibiotics , the antibiotic fee and the total admission fee . The average total admission fee decreased by 2.3 % ( p = 0.034 ) , and the average antibiotic-fee dropped by 68.4 % ( p < 0.01 ) . The average injected vials of cephalothin  decreased by 4.3 , and the vials of gentamycin decreased by 3.3 ( p < 0.01 ) . As for the rate of operative site infection and urinary tract infection during hospitalization and within 7 days of discharge , no statistical differences were found between the 2 groups ( p = 0.735 ; p = 0.917 ) . CONCLUSION This pilot study revealed that a short course of prophylactic antibiotics was as efficacious as a longer course in preventing postoperative infection . It was also cost-effective OBJECTIVES To determine lower genital tract carriage rates of C. trachomatis , N. gonorrhoeae and bacterial vaginosis among women seeking termination of pregnancy . To compare two clinical management strategies for minimising the risks of infective morbidity after induced abortion . DESIGN Prevalence of infections was assessed by screening women undergoing abortion . Clinical management strategies were compared by a r and omised trial . SETTING The gynaecology departments of four hospitals in Scotl and . PARTICIPANTS 1672 women undergoing induced abortion . INTERVENTIONS Women r and omised to prophylaxis received metronidazole 1 g rectally before abortion plus doxycycline 100 mg twice daily for seven days . Women r and omised to screen- and -treat received appropriate antibiotics only if screening proved positive for one or more infection . MAIN OUTCOME MEASURES Prevalences of infections ; morbidity in the eight weeks following abortion as assessed by reported symptoms , general practitioner consultation and prescription rates and hospital re-attendances ; costs to the NHS of alternative managements . RESULTS Prevalence rates : C. trachomatis 5.6 % ; N gonorrhoeae 0.19 % ; bacterial vaginosis 17.5 % . Overall , women allocated to receive prophylaxis had lower rates of measures of short term infective morbidity than those allocated to screen- and -treat . These differences only reached statistical significance for women who were reported negative on screening . The direct costs to the NHS of prophylaxis and screen- and -treat were calculated to be 8.17 and 18.34 per woman , respectively . CONCLUSIONS Prevalences of lower genital tract infections which have been implicated in increased rates of infective morbidity after abortion are similar to those reported elsewhere . Universal antibiotic prophylaxis is at least as effective as a policy of screen- and -treat in minimising the risk of short term infective morbidity and is far more cost efficient Objective : The purpose of this study was to investigate the efficacy of 200 mg of prophylactic doxycycline in preventing pelvic infection after curettage for spontaneous ( incomplete ) abortion . Methods : A r and omized , prospect i ve , double-blinded study was carried out involving 300 women with an incomplete abortion who were given either placebo or 200 mg of doxycycline orally 30–60 min prior to curettage .  A hematocrit , WBC count , pregnancy test , syphilis serology , Neisseria gonorrhoeae culture , and Micro Trak ( monoclonal antibody test , Syba , San Jose , CA ) for Chlamydia trachomatis were performed . The patients were scheduled for follow-up 2 weeks later . Antibiotic administration for any reason as well as the postoperative infection rate in these women was assessed . Results : Eleven women were excluded from analysis , leaving 289 evaluable . N. gonorrhoeae was isolated from 6 ( 2 % ) women and C. trachomatis from 8 ( 3 % ) women , and the syphilis serology was serofast in 4 ( 1 % ) women . Endometritis complicated the procedure in 4 women who received placebo and in 1 woman who received doxycycline ( P = 0.22 ) . Conclusion : Prophylactic doxycycline is not effective in preventing pelvic infection after curettage for spontaneous ( incomplete ) abortion Two consecutive open studies were performed of the efficacy of a prophylactic cefuroxime/metronidazole combination  in abdominal hysterectomy . The first group received a 24-h regimen , the second group a  single pre-operative dose . The incidence of post-operative wound infections and urinary tract infections were similar in both groups [ wound infections in 1/75 versus 2/84 patients ( NS ) , urinary tract infections 4/75 versus 3/84 patients ( NS ) , respectively , in the 24-h group and single-dose group ] . No significant differences in other parameters , such as pyrexia and duration of post-operative hospitalization , could be detected The aim of evidence -based guidelines is primarily to improve patient outcomes without adding to the existing cost of care because both payers and policymakers want to identify health care costs that do not result in benefit to the patient . The purpose of the reported project was to generate a practice guideline for the treatment of uncomplicated acute cystitis in a female population , to determine the extent to which the guideline would be used by providers and to measure the cost and quality of outcomes from its use . A retrospective chart review was used to gather pre- guideline practice and cost data . Measurements included the type , frequency , and duration of antibiotic therapy and the use of urine cultures and both complications and routine followup visits . The implementation of an outpatient practice guideline result ed in a significant change in antibiotic prescribing and a trend toward a change in ordering cultures and clinic followup . There was also a significant decrease in treatment costs We did a double-blind , r and omized , placebo-controlled study to assess the incidence of infectious complications and the protective effect of antibiotic administration during operative hysteroscopic procedures in an office setting . A total of 1046 consecutively enrolled women with intrauterine lesions were r and omly allocated to the reference group ( 523 patients administered with 1 g of cefazolin intramuscularly ) and the study group ( 523 patients administered with 10 mL of isotonic sodium chloride solution ) , and treated in office setting by operative hysteroscopy for endometrial polypectomy , uterine septa , submucosal myomas , and intrauterine adhesions . The primary outcome measure was the computation of difference between groups in postsurgical infectious complications occurring in the 5 days after the procedures . The time spent in performing the various procedures did not differ significantly ( P > .05 ) between the groups . With respect to the overall rate of postsurgical infection , we found that 12 ( 1.15 % ) of 1046 patients referred with symptoms related to infective complications  , 7 ( 1.3 % of 523 women ) in the study —untreated — group and 5 ( 1.0 % of 523 women ) in the reference group . Such incidences did not differ significantly between the groups ( P > .05 ) . Antibiotics were prescribed in all cases of postsurgical infection and the infective process resolved in few days . None of these patients developed serious infections with adnexal involvement , as confirmed by clinical and ultrasounds evaluation . The results of the current study would support the American College of Obstetricians and Gynecologists recommendation not to prescribe routine antibiotic administration in the case of hysteroscopic surgery Three different antibiotic regimens ( trospectomycin plus azteonam , clindamycin plus azteonam , and triple antibiotics-ampicillin plus clindamycin plus gentamicin ) were all effective in treating patients with postcesarean endometritis . Patients are frequently cured clinical ly despite the fact that the offending organisms may be isolated in post-treatment cultures . Treatment of  postcesarean endometritis  without obtaining endometrial cultures is acceptable gynecologic practice . Obtaining post-treatment cultures is clearly not cost effective nor clinical ly beneficial . Drug treatment efficacy should be evaluated by clinical response . This communication is the first to report the new antibiotic , trospectomycin , in the treatment of postcesarean endometritis .  Further clinical trials are currently underway
Benefits , harms , and costs Guideline implementation should result in a reduction of cost and related harm of administering antibiotics when not required and a reduction of infection and related morbidities when antibiotics have demonstrated a proven benefit .
Abstract Objective To review the evidence and provide recommendations on antibiotic prophylaxis for gynaecologic procedures .
Outcomes Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in gynaecologic procedures .