Prophylactic antibiotics for intrauterine device insertion: a metaanalysis of the randomized controlled trials

We evaluated the effectiveness of prophylactic antibiotic administration before IUD insertion in reducing the incidence of pelvic inflammatory disease, unscheduled visits back to the clinician, and IUD discontinuations within 3 months of insertion. We performed a metaanalysis of all known randomized controlled trials comparing an antibiotic (either oral doxycycline or azithromycin) versus a placebo or no treatment. Use of prophylaxis significantly reduced the frequency of unscheduled return visits (odds ratio 0.82; 95% CI 0.70, 0.98). The protection against pelvic inflammatory disease was smaller and not statistically significant 0.89 (95% CI 0.53, 1.51). No significant effect on premature IUD discontinuation was evident. Use of either doxycycline or azithromycin before IUD insertion offered little observable benefit in the US. Prophylaxis reduced unscheduled visits and possibly PID in developing countries, which have higher rates of sexually transmitted diseases than in the US. A more important finding in these trials is the low incidence of pelvic inflammatory disease with or without prophylactic antibiotics.