Related Experiment Videos
Antibiotic prophylaxis for intrauterine contraceptive device insertion
1Family Health International, P. O. Box 13950, Research Triangle Park, North Carolina 27709, USA. dgrimes@fhi.org
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Prophylactic antibiotics before IUD insertion offer minimal benefit in preventing pelvic inflammatory disease. While slightly reducing unscheduled provider visits, routine antibiotic use for IUDs is not cost-effective due to low infection risk.
Area of Science:
- Reproductive Health
- Infectious Disease Prevention
- Contraception
Background:
- Intrauterine devices (IUDs) are effective contraceptives but their use is limited by concerns regarding upper genital tract infections, specifically pelvic inflammatory disease (PID).
- The primary mechanism for IUD-related infection is believed to be the introduction of bacteria into the endometrial cavity during insertion.
- Prophylactic antibiotics have been shown to reduce infection risk after procedures like induced abortion.
Purpose of the Study:
- To evaluate the efficacy of prophylactic antibiotic administration prior to IUD insertion.
- To determine the impact of antibiotics on reducing IUD-related complications, including PID and early device removal within three months.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing prophylactic antibiotics with placebo or no treatment.
- Searches of major databases (MEDLINE, EMBASE, CENTRAL) and contact with experts identified four relevant RCTs.
- Data extraction and analysis were performed by two independent reviewers using established methodologies.
Main Results:
- Prophylactic doxycycline or azithromycin did not significantly reduce the odds of developing pelvic inflammatory disease (OR 0.89; 95% CI 0.53-1.51).
- A statistically significant, though small, reduction in unscheduled provider visits was observed with antibiotic prophylaxis (OR 0.82; 95% CI 0.70-0.98).
- Antibiotic use showed no significant effect on the likelihood of IUD removal within 90 days (OR 1.05; 95% CI 0.68-1.63).
Conclusions:
- Pre-insertion antibiotic prophylaxis with doxycycline or azithromycin provides limited clinical benefit for IUD users.
- The cost-effectiveness of routine antibiotic prophylaxis is questionable, given the marginal reduction in unscheduled visits and the low overall risk of IUD-associated infection.
- These trials consistently demonstrated a low incidence of IUD-related infections, irrespective of antibiotic prophylaxis.