Antibiotic use in obstetric fistula repair: single blinded randomized clinical trial

The beneficial effect of extended use over single dose of antibiotics in obstetric fistula repair is unknown, however, is practiced widely.

From September 2006 to February 2008, a total of 722 eligible women with obstetric fistula were randomly assigned to receive either of 80 mg Gentamycin IV (immediately after spinal anesthesia), or extended use of Amoxicillin, Chloramphenicol or Cotrimexazole (postoperatively) and followed post operatively. Post surgery progresses, interventions andfinal results were recorded on the standard format prepared.

A total of 722 study participants were followed, the mean age was 25.1 years (24.6, 25.6), 90.4% were illiterate, 33.2% were divorced and 53.2% were injured during their first delivery. About 81% of women had bladder injury without rectal and anal sphincter involvement, and over 70% had prolonged labor (labour lasted over 24 hours). Proportion of women with the above mentioned parameters was similar among the two groups. Additional procedures (Martius fat graft and minilaparatomy); the amount of blood loss; and the length ureteric catheters and vaginal pack stayed were not different among the two groups. The proportion of women with successfild fistula closure was similar among the two groups; 94.5% (92.1, 96.9) for single dose of Gentamycin vs. 89.4% (86.2, 92.6) for extended dose of other antibiotics. Hospital stay; proportion of women with fever, post repair infection; post operation stress incontinence and other residual incontinences were not different among the two groups.

Single dose of Gentamycin (80 mg IV) given preoperatively at the administration of spinal anesthesia appears to be equally effective as the extended use of either of or combination of Amoxicillin, Chloramphenicol and Cotrimexazole.