The document discusses the use of antibiotic prophylaxis for incomplete abortion. Studies show that bacterial vaginosis organisms are commonly found in cervical canals of incomplete abortion patients. Prophylactic antibiotics are recommended to prevent infection, though evidence is unclear on specific regimens. Nitroimidazoles and tetracyclines like doxycycline are good options for prophylaxis or treatment of post-abortion infection. The need for antibiotic treatment should be individualized based on risk factors.

1. To Give or Not To Give
The Use of Antibiotic in Incomplete Abortion
Liza Tarca-Cruz, MD
OB Resident

2. Journals
• Potential Pathogens in the Lower Genital Tract at
Manual Vacuum Aspiration for Incomplete Abortion in
Korle Bu Teaching Hospital, Ghanna
A.T Lasser, R.M.K., Adanu, M.J Newman and J.A Opintah
East African Medical Journal Vol. 81, No. 8 August 2004
• The Cochrane Collaboration on Antibiotic for Incomplete
Abortion (Review)
May W, Gulmezoglo AM, Ba-Thike K
WHO, The Cochrane Library , 2007, Issue 4

3. Journals
• Clinical Guidelines: Prevention of Infection After Induced
Abortion
Society of Family Planning 20102, October 2010
• SOGC Clinical Practice Guidelines: Antibiotic
Prophylaxis in Gynaecologic Procedures
Nancy Van Eyk, MD et al, J Obstetr Gynaecol Can 2012:34(4):382-391

4. Potential Pathogens in the Lower Genital Tract at Manual Vacuum
Aspiration for Incomplete Abortion in Korle Bu Teaching Hospital, Ghanna

5. Potential Pathogens in the Lower Genital Tract at Manual Vacuum
Aspiration for Incomplete Abortion in Korle Bu Teaching Hospital, Ghanna

6. The Cochrane Collaboration on Antibiotic for Incomplete Abortion
(Review)

7. The Cochrane Collaboration on Antibiotic for Incomplete Abortion (Review)

8. Clinical Guidelines: Prevention of Infection After Induced Abortion
• The features of antibiotics appropriate for use as
prophylaxis
–
–
–
–
Low toxicity
Established safety record
Not routinely used for treatment of serious infections
Spectrum of activity includes micro-organisms most likely to
cause infections
– Reaches useful concentration in relevant tissues during
procedure
– Administered for short duration
– Administered such that it is present at the surgical sites at the
start of the procedure

9. Clinical Guidelines: Prevention of Infection After Induced Abortion
• Does antibiotic prophylaxis lower the risk of infection
following surgical abortion?
– The risk of infection was lower in the group receiving antibiotics,
though the difference is not statistically significant in the 8
studies done.
– The benefits of antibiotic prophylaxis are less clear in a
population at very low risk.

10. Clinical Guidelines: Prevention of Infection After Induced Abortion
• Which antibiotic is best for prevention of postabortal
infection?
– Nitromidazoles (metronidazoles and tinidazole)
– Tetracyclines (doxycycline)

11. SOGC Clinical Practice Guidelines: Antibiotic Prophylaxis in Gynaecologic
Procedures
• 2 Radomized Placebo Controlled Trials
– Assess the effectiveness of prophylactic antibiotics to
reduce infectious morbidity following evacuation of
uterus after incomplete abortion
– Prophylactic antibiotics are not suggested to
reduce infectious morbidity following surgery for
a missed or incomplete abortion. (I-E)

12. SUMMARY
• Organisms responsible for bacterial
vaginosis were the most frequently
isolated potential pathogen in the cervical
canal of patients with incomplete abortion.
• Management of incomplete abortion of
patients should include antibiotic
prophylaxis against bacterial vaginosis.

13. SUMMARY
• No evidence to either recommend or to
abandon the use of prophylactic
antibiotics in women with an incomplete
abortion.
• A single dose may be more suitable.
– To minimize risk of adverse reactions &
resistance

14. SUMMARY
• Antibiotics are generally given when there
are signs of infection.
• Prophylaxisis antibiotics are not suggested
to reduce infectious morbidity following
surgery for a missed or incomplete
abortion.
– Perioperative oral doxycycline given up to
12hours before a surgical abortion

15. SUMMARY
• The best antibiotic for prevention of
postabortal infections are nitroimidazoles
and tetracyclines.
– Doxycycline 200mg preoperatively
– Doxycyline 100mg 1 hour before and 200mg
1 ½ hour after
– Tetracyclines 500mg QID x 1 week

16. CONCLUSION
Giving of prophylactic or post operative
antibiotic to patient’s who had incomplete
abortion and will undergo completion
curettage should be individualized.
High risk patients should receive antibiotic
while low risk may or may not have treatment.
However, a single dose may be beneficial
rather than a complete antibiotic course