Prophylactic antibiotics for transcervical intrauterine procedures

The administration of antibiotics before or following transcervical intrauterine procedures may prevent infection. The lower genital tract is an area which is abundant with normal flora (resident bacteria) so that operative procedures which pass through it may increase the risk of infection. The operative procedure may cause contamination of the uterine cavity with vaginal or cervical flora, or both. In addition, the associated trauma may compromise the ability of the uterus to combat infection. The prophylactic administration of antibiotics (giving antibiotics before the development of any infection) in women undergoing transcervical intrauterine procedures may prevent infection post-procedure. There have been no randomised controlled trials evaluating the usefulness of antibiotics for the prevention of infection after these procedures. Therefore we could not draw any conclusions regarding the use of prophylactic antibiotics for the prevention of post-procedure transcervical intrauterine infections

Authors' conclusions: 

At this time, there are no randomised controlled trials that assess the effects of prophylactic antibiotics on infectious complications following transcervical intrauterine procedures. It is, therefore, not possible to draw any conclusions regarding the use of prophylactic antibiotics for the prevention of post-procedure transcervical intrauterine infections.

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Background: 

The transcervical intrauterine route is commonly used for operative gynaecological procedures in women. The vagina is an area of the body that is abundant with normal bacterial flora. An operative procedure through the vagina may, therefore, be considered to have added potential for post-procedure infection. Prophylactic antibiotics may play a role in the prevention of post-procedure transcervical intrauterine infections.

Objectives: 

To assess the effectiveness and safety of antibiotic prophylaxis compared to placebo or no treatment in women undergoing transcervical intrauterine procedures.

Search strategy: 

The search strategy was based on the Cochrane Menstrual Disorders and Subfertility Group (MDSG) search strategy. We searched the following databases: the Cochrane MDSG Specialised Register; Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (to August 2012); MEDLINE (1946 to August 2012); EMBASE (1980 to August 2012); PsycINFO (to August 2012); CINAHL (to August 2012), Biological Abstracts (1966 to August 2012) and AMED (1966 to August 2012).

Selection criteria: 

We planned to include only truly randomised controlled trials that compared antibiotic prophylaxis with placebo or no treatment in order to prevent infectious complications after transcervical intrauterine procedures. Controlled clinical trials without randomisation and pseudo-randomised trials were excluded.

Data collection and analysis: 

No data collection or analysis was done because no trials were eligible for inclusion in the review.

Main results: 

The search did not identify any randomised controlled trials investigating the effect of antibiotic prophylaxis compared to placebo or no treatment in women undergoing transcervical intrauterine procedures.

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