Prophylactic antibiotics for intrauterine device insertion: a metaanalysis of the randomized controlled trials - PubMed (original) (raw)
Meta-Analysis
Prophylactic antibiotics for intrauterine device insertion: a metaanalysis of the randomized controlled trials
D A Grimes et al. Contraception. 1999 Aug.
Abstract
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.
PIP: This meta-analysis of randomized controlled trials compared an antibiotic prophylaxis (either oral doxycycline or azithromycin) with placebo or no treatment on risk of pelvic inflammatory disease (PID), incidence of unscheduled return visits to the clinician, and IUD discontinuation within 3 months of insertion. The analysis demonstrated that the use of prophylaxis significantly reduced the frequency of unscheduled return visits. The protection against PID was smaller and was not statistically significant. Furthermore, the analysis showed that no significant effect on premature IUD discontinuation was evident. Use of either oral doxycycline or azithromycin before IUD insertion offered little observable benefit in the US. Prophylaxis reduces unscheduled visits and possibly PID in developing countries, where rates of sexually transmitted diseases are higher compared to the US. A more important finding in these trials was the low incidence of PID with or without prophylactic antibiotics.
Similar articles
- Antibiotic prophylaxis for intrauterine contraceptive device insertion.
Grimes DA, Schulz KF. Grimes DA, et al. Cochrane Database Syst Rev. 2001;(2):CD001327. doi: 10.1002/14651858.CD001327. Cochrane Database Syst Rev. 2001. PMID: 11405986 Review. - Preventing IUCD-related pelvic infection: the efficacy of prophylactic doxycycline at insertion.
Sinei SK, Schulz KF, Lamptey PR, Grimes DA, Mati JK, Rosenthal SM, Rosenberg MJ, Riara G, Njage PN, Bhullar VB, et al. Sinei SK, et al. Br J Obstet Gynaecol. 1990 May;97(5):412-9. doi: 10.1111/j.1471-0528.1990.tb01828.x. Br J Obstet Gynaecol. 1990. PMID: 2196934 Clinical Trial. - Antibiotic prophylaxis for intrauterine contraceptive device insertion.
Grimes DA, Schulz KF. Grimes DA, et al. Cochrane Database Syst Rev. 2001;(1):CD001327. doi: 10.1002/14651858.CD001327. Cochrane Database Syst Rev. 2001. PMID: 11279714 Updated. Review. - Prevention of IUD-related pelvic infection: the efficacy of prophylactic doxycycline at IUD insertion.
Ladipo OA, Farr G, Otolorin E, Konje JC, Sturgen K, Cox P, Champion CB. Ladipo OA, et al. Adv Contracept. 1991 Mar;7(1):43-54. doi: 10.1007/BF01850718. Adv Contracept. 1991. PMID: 1872196 Clinical Trial. - Antibiotic prophylaxis for intrauterine contraceptive device insertion.
Grimes DA, Schulz KF. Grimes DA, et al. Cochrane Database Syst Rev. 2000;1999(2):CD001327. doi: 10.1002/14651858.CD001327. Cochrane Database Syst Rev. 2000. PMID: 10796777 Free PMC article. Updated. Review.
Cited by
- A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus.
Stringer EM, Kaseba C, Levy J, Sinkala M, Goldenberg RL, Chi BH, Matongo I, Vermund SH, Mwanahamuntu M, Stringer JS. Stringer EM, et al. Am J Obstet Gynecol. 2007 Aug;197(2):144.e1-8. doi: 10.1016/j.ajog.2007.03.031. Am J Obstet Gynecol. 2007. PMID: 17689627 Free PMC article. Clinical Trial. - [The family doctor facing IUD insertion].
Arribas-Mir L, Ortega Del Moral A, Jódar-Reyes M. Arribas-Mir L, et al. Aten Primaria. 2005 Dec;36(10):576-84. doi: 10.1016/s0212-6567(05)70570-9. Aten Primaria. 2005. PMID: 16507294 Free PMC article. Review. Spanish. No abstract available. - Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS.
Bednarek PH, Jensen JT. Bednarek PH, et al. Int J Womens Health. 2010 Aug 9;1:45-58. doi: 10.2147/ijwh.s4350. Int J Womens Health. 2010. PMID: 21072274 Free PMC article. - U.S. Selected Practice Recommendations for Contraceptive Use, 2024.
Curtis KM, Nguyen AT, Tepper NK, Zapata LB, Snyder EM, Hatfield-Timajchy K, Kortsmit K, Cohen MA, Whiteman MK; Contributors. Curtis KM, et al. MMWR Recomm Rep. 2024 Aug 8;73(3):1-77. doi: 10.15585/mmwr.rr7303a1. MMWR Recomm Rep. 2024. PMID: 39106301 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical