Prophylactic antibiotics for preventing genital tract infection in women undergoing surgical procedures for incomplete abortion: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Findings about the effect of prophylactic antibiotics in preventing genital tract infection (GTI) associated with surgical procedures used for incomplete abortions are conflicting. Some reported a decrease in infection associated with the use of antibiotic prophylaxis, while others found no significant reduction in GTI. To systematically synthesize the evidence on the effect of prophylactic antibiotics compared to placebo in women undergoing surgical procedures for incomplete abortion. In February 2020, PubMed, Embase and Cochrane Central for Register of Controlled Trials were searched for relevant published randomized controlled trials. Randomized controlled trials reporting GTI following surgical procedures for incomplete abortion and comparing antibiotic prophylaxis against placebo. Meta-analysis using inverse variance heterogeneity model included a-priori determined subgroup and sensitivity analyses were conducted. The quality of evidence was assessed using GRADE. A total of 16,178 women who participated in 24 eligible randomized controlled trials published between 1975 and 2019 were included. Pooled estimates showed the risk of GTI following surgical procedures after incomplete abortion was significantly lower among those who had prophylactic antibiotics (RR=0.72; 95%CI 0.58-0.90; I =49%). There was no significant effect of antibiotics in women in low and middle income countries (3 studies, 3,579 participants, RR= 0.90; 95%CI 0.50-1.62; I =63%), while it was clinically and statistically significant among women high income countries (21 studies, 12,599 participants, RR=0.67; 95%CI 0.53-0.84; I =44%), with strong level of evidence as assessed by GRADE. This study provides evidence that antibiotic prophylaxis is beneficial in reducing post-abortion GTI among women undergoing surgical procedures for incomplete abortion. More studies are needed from low and middle income countries.