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Antibiotic prophylaxis for intrauterine contraceptive device insertion.
1Family Health International, P. O. Box 13950, Research Triangle Park, North Carolina, USA, 27709. dgrimes@fhi.org
The Cochrane Database of Systematic Reviews
|May 2, 2001
Summary
Prophylactic antibiotics before IUD insertion offer minimal protection against pelvic inflammatory disease. While slightly reducing unscheduled 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 over upper genital tract infections like pelvic inflammatory disease (PID).
- The primary mechanism for IUD-related infection is thought 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 assess the impact on IUD-related complications, specifically PID and early device removal, within three months of insertion.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searches conducted in MEDLINE, EMBASE, CENTRAL, and through expert consultation to identify relevant studies.
- Data extraction and validity assessment performed by two independent reviewers; statistical analysis using the Peto modified Mantel-Haenszel technique.
Main Results:
- Prophylactic doxycycline or azithromycin showed no significant reduction in the odds of developing pelvic inflammatory disease (OR 0.89; 95% CI 0.53-1.51).
- A small, marginally significant reduction in unscheduled provider visits was observed (OR 0.82; 95% CI 0.70-0.98).
- Antibiotic prophylaxis had 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 benefit in preventing IUD-related complications.
- The cost-effectiveness of routine antibiotic prophylaxis for IUD insertion is questionable.
- The overall risk of IUD-associated infection, with or without prophylaxis, was found to be low in the included trials.