Antibiotics for incomplete abortion: Cochrane systematic review


Assessed as up to date: 2007/07/01


Unsafe abortions result not only in costs for acute care but may also be responsible for longer-term complications such as pelvic inflammatory disease, damage to reproductive organs, and secondary infertility. If effective, antibiotic prophylaxis at the time of the procedure can potentially prevent these adverse consequences.


The value of routine antibiotics before surgical evacuation of the uterus in women with incomplete abortion is controversial. In some health centres antibiotic prophylaxis is advised; in others antibiotics are only prescribed when there are signs of infection. The objective of this review is to evaluate the effectiveness of routine antibiotic prophylaxis to women with incomplete abortion.

Search strategy

We searched the Cochrane Controlled Trials Register, Pubmed/MEDLINE, EMBASE and Popline. Date of last search: January 2007.

Selection criteria

Randomised trials comparing a policy of routine antibiotic prophylaxis with no routine prophylaxis were eligible for inclusion.

Data collection and analysis

Data extraction was conducted by two reviewers independently. Trial quality was assessed.

Main results

One study involving 140 women was included. A second well-conducted trial was excluded because of high losses to follow-up. No differences were detected in postabortal infection rates with routine prophylaxis or control. However, compliance with antibiotic treatment was also low.

Authors' conclusions

There is not enough evidence to evaluate a policy of routine antibiotic prophylaxis to women with incomplete abortion.


May Win, Gülmezoglu A Metin, Ba-Thike Katherine


Not enough evidence on routine antibiotics to prevent infection for women seeking care after incomplete abortion, but a single dose may be more suitable

Incomplete abortions cause many complications and the deaths of tens of thousands of women each year. Women who seek health care after an incomplete abortion usually come for problems from bleeding too much or infection. Antibiotics are generally given when there are signs of infection. The review of trials showed difficulties for women in continuing to take antibiotics and returning for care, so single dose antibiotics may be more suitable in these circumstances. The trials did not provide enough evidence to show the effects of routine antibiotics for women after incomplete abortion.

Reviewer's Conclusions

Implications for practice

There is no evidence to either recommend or to abandon the use of prophylactic antibiotics in women with an incomplete abortion. Clinical judgment would need to be used by the health care provider.

Implications for research

There is a real and urgent need to find out whether antibiotics should be routinely used in cases of incomplete abortion. The policy and cost implications arising from this research will be tremendous, and randomised clinical trials comparing antibiotics currently in use with no antibiotics are strongly recommended.

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