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 Randomized study of antibiotic prophylaxis for general and gynaecological surgery from a single centre in rural Africa Prophylactic antibiotic use in elective inguinal hernioplasty in a trauma center Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial Randomized clinical trial of single‐dose antibiotic prophylaxis for non‐reconstructive breast surgery Preventing major operative site infection after radical abdominal hysterectomy and pelvic lymphadenectomy. [Antibiotic prophylaxis in breast surgery. Preliminary resuls of a multicenter randomized study on 1400 cases]. Prophylaxis in gynaecological surgery: a prospective randomized comparison between single dose prophylaxis with amoxycillin/clavulanate and the combination of cefuroxime and metronidazole. Evidence on antibiotic prophylaxis for cesarean section alone is not sufficient to change the practices of doctors in a teaching hospital. Prophylactic Antibiotics for Suction Curettage in Incomplete Abortion Antibiotic prophylaxis in abdominal hysterectomy, with special reference to the duration of the prophylaxis Amoxycillin/clavulanate prophylaxis in gynecologic surgery. [General or individually calculated preventive antibiotic administration. Summary of the Magdeburg appendicitis study]. A Multicenter, Double-Blind, Randomized, Placebo-Controlled Study to Assess Whether Antibiotic Administration Should Be Recommended During Office Operative Hysteroscopy Effect of optimized antibiotic prophylaxis on the incidence of surgical site infection.
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 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 Purpose In this double-blind prospect i ve r and omized trial , our objective was to investigate the effect of antibiotic prophylaxis in patients undergoing elective inguinal hernia surgery with mesh repair in a large-volume tertiary referral trauma center . Methods Eligible patients were assigned r and omly to either an antibiotic prophylaxis group or a control group . Patients in the prophylaxis group were given 1 g cefazolin by IV bolus injection whereas the placebo control group received an equal volume of sterile saline preoperatively . A Lichtenstein repair was done in all cases . The patients were examined for surgical site infection ( SSI ) and other postoperative local complications before discharge , and reexamined 3 , 5 , 7 , and 30 days after discharge . Results Groups were well matched for age , sex , coexisting diseases , ASA scores , type of hernia , type of anesthesia , duration of surgery . Incidence of infection was 7 % in the control group ( 7/100 ) and 5 % in the prophylaxis group ( 5/100 ) ( P = 0.38 ) . All the infections were superficial and responded well to drainage and proper antibiotic therapy . All other postoperative complications were similar in the two groups . Conclusions In our setting s antibiotic prophylaxis has no significant effect on the incidence of SSI in elective repair of inguinal hernias with mesh . The most effective way to reduce the incidence of infection in prosthetic repair may be a specific center for treatment of abdominal wall hernias 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 The aim of this r and omized clinical trial was to determine whether a single intravenous dose of 2 g flucloxacillin could prevent wound infection after primary non‐reconstructive breast surgery Twenty-one women who underwent radical abdominal hysterectomy and pelvic lymphadenectomy were enrolled in a prospect i ve , comparative , r and omized , placebo-controlled clinical trial of antimicrobial prophylaxis . Preoperative endocervical flora was identified and was similar in pre- and postmenopausal private and clinic service women ; 46 % of the 119 preoperative isolates produced beta-lactamase enzyme . Women were given three doses of either placebo or cefoperazone plus sulbactam , an irreversible beta-lactamase enzyme inhibitor . Three women ( 27 % ) given placebo developed abdominal incision infections ; one women given placebo also developed a pelvic infection . None given antibiotic developed operative site infection , but one women developed a drain site infection . A major operative site infection rate of 27 % observed with placebo is high enough to warrant prophylaxis . Although antimicrobial prophylaxis at radical hysterectomy and pelvic lymphadenectomy eradicted operative site infection in our patient population s , a literature review indicates that individual determination of a requirement for prophylaxis is necessary UNLABELLED Breast surgery is classified among the procedures performed in clean surgery and is associated with a low incidence of wound infection ( 3 - 15 % ) . The objective of this study was to evaluate the advantages antibiotic prophylaxis  in patients undergoing breast surgery .  A multicenter r and omized controlled study was performed between January 2008 and November 2008 . One thous and four hundred patients were enrolled in prospect i ve r and omized study ; surgical wound infection was found in 41 patients ( 2.93 % ) . In our RCT we have shown that in breast surgery antibiotic prophylaxis does not present significant advantages in patients with potential risk of infection ( 17 patients , 2.42 % , subjected to antibiotic prophylaxis vs 24 patients , 3.43 % , without antibiotic prophylaxis ) ( P = 0.27 ) . In patients with drainage there is a significant minor incidence of wound infections in patients receiving antibiotic prophylaxis ( 5 patients , 0.92 % , subjected to antibiotic prophylaxis vs 14 patients , 3.09 % , without antibiotic prophylaxis ) ( P = 0.02 ) . CONCLUSION This study is only a preliminary RCT to be followed by a study which should be enrolled more patients in order to get the results as statistically significant A prospect i ve r and omized comparison of a single pre-operative dose of 2.2 g amoxycillin/clavulanate versus the combination of 1.5 g cefuroxime plus 0.5 g metronidazole was conducted in 467 women , who underwent gynaecological surgery . The incidence of febrile morbidity , urinary tract infection , wound infection and the use of post-operative antimicrobial agents was similar in the two groups .  Amoxycillin/clavulanate  is as effective as a combination of cefuroxime and metronidazole and less expensive 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 : 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 used as antibiotic prophylaxis in abdominal and gynecologic surgery being effective against most bacteria , including anaerobes w1,2x . Different reported protocol s of antibiotic prophylaxis tend to reduce doses and it is now usual to give a single administration before the start of the surgery w3x . To evaluate this concept , we compared the efficacy of a single preoperative dose of amoxycillinyclavulanate ( AyC ) with a two-dose administration , one 30 min before the operation and the other 8 h later . The study included 358 women admitted to our Department for surgery . Exclusion criteria were : allergy to the study drug , serious renal and yor hepatic diseases , antibiotic or corticosteroid treatment in the 14 days before surgery . Subjects were assigned r and omly to one of the two treatment groups : 190 patients received 2.2 g of AyC i.v . before surgery ( group 1 ) , while 168 patients received a second dose after 8 h ( group 2 ) . St and ard preoperative and postoperative assessment was carried out in all patients . All operations were performed by the same gynecologists . The subjects were divided according to : type of surgery A prospect i ve r and omized clinical trial was performed to determine the efficiency of single-dose antibiotic prophylaxis in preventing septic complications after appendectomy . The infection rate increased significantly in the control group without antibiotic prophylaxis ( 9.3 % to 20.3 % ) . Older patients with severe appendicitis had more advantages from the prophylaxis than younger one . We have suggested to perform antibiotic prophylaxis individually only in those patients with high risk of septic complications after appendectomy 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 OBJECTIVE To compare the rate of surgical site infection ( SSI )  before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented . To demonstrate that a more prudent , restrictive policy would not have a detrimental effect on patient outcomes . DESIGN Before-after trial with prospect i ve SSI surveillance in the Dutch nosocomial surveillance network ( Preventie Ziekenhuisinfecties door Surveillance [ PREZIES ] ) , using the criteria of the Centers for Disease Control , including postdischarge surveillance for up to 1 year . METHODS During a preintervention period and a postintervention period ( both 6 - 13 months ) , 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates . The study was limited to commonly performed surgical procedures in 4 specialties : vascular , intestinal , gynecological and orthopedic surgery . Selected risk factors for analysis were sex , age , American Society of Anesthesiologists classification , wound contamination class , duration of surgery , length of hospital stay before surgery , and urgency of surgery ( elective or acute ) . RESULTS A total of 3,621 procedures were included in the study , of which 1,668 were performed before the intervention and 1,953 after . The overall SSI rate decreased from 5.4 % to 4.5 % ( P=.22 ) . Among the procedures included in the study , the largest proportion ( 55 % ) were total hip arthroplasty , and the smallest proportion ( 2 % ) were replacement of the head of the femur . SSI rates varied from 0 % for vaginal hysterectomy to 21.1 % for femoropopliteal or femorotibial bypass surgery . Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention ( P>.1 ) . CONCLUSIONS An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery , as measured by SSI rate
Results Prophylactic antibiotics  prevent inflammatory complications after gynaecological surgery .
Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina .
Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin .
No benefit has been shown for the combination of antibiotics as prophylaxis .
No difference has been shown between the long-term and short-term use of antibiotics .
There is no need for the primary use of an anaerobic antibacterial agent .
Conclusion Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries
Purpose The aim of this study was to systematic ally review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations .