Abstract
Objective
To review the evidence and provide recommendations on antibiotic prophylaxis for gynaecologic
procedures.
Outcomes
Outcomes evaluated include need and effectiveness of antibiotics to prevent infections
in gynaecologic procedures.
Evidence
Medline and The Cochrane Library were searched for articles published between January
1978 and January 2011 on the topic of antibiotic prophylaxis in gynaecologic procedures.
Results were restricted to systematic reviews, randomized control trials/ controlled
clinical trials, and observational studies. Searches were updated on a regular basis
and incorporated in the guideline to June 2011. Grey (unpublished) literature was
identified through searching the websites of health technology assessment and health
technology assessment-related agencies, clinical practice guideline collections, clinical
trial registries, and national and international medical specialty societies.
Values
The quality of evidence obtained was rated using the criteria described in the Report
of the Canadian Task Force on Preventative Health Care (Table 1).
Benefits, harms, and costs
Guideline implementation should result in a reduction of cost and related harm of
administering antibiotics when not required and a reduction of infection and related
morbidities when antibiotics have demonstrated a proven benefit.
Recommendations
- 1All women undergoing an abdominal or vaginal hysterectomy should receive antibiotic prophylaxis (I-A).
- 2All women undergoing laparoscopic hysterectomy or laparoscopically assisted vaginal hysterectomy should receive prophylactic antibiotics (III-B).
- 3The choice of antibiotic for hysterectomy should be a single dose of a first-generation cephalosporin. If patients are allergic to cephalosporin, then clindamycin, erythromycin, or metronidazole should be used (I-A).
- 4Prophylactic antibiotics should be administered 15 to 60 minutes prior to skin incision. No additional doses are recommended (I-A).
- 5If an open abdominal procedure is lengthy (e.g., > 3 hours), or if the estimated blood loss is > 1500 mL, an additional dose of the prophylactic antibiotic may be given 3 to 4 hours after the initial dose (III-C).
- 6Antibiotic prophylaxis is not recommended for laparoscopic procedures that involve no direct access from the abdominal cavity to the uterine cavity or vagina (l-E).
- 7All women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence should receive a single dose of first- generation cephalosporin (III-B).
- 8Antibiotic prophylaxis is not recommended for hysteroscopic surgery (II-2D).
- 9All women undergoing an induced (therapeutic) surgical abortion should receive prophylactic antibiotics to reduce the risk of post-abortal infection (I-A).
- 10Prophylactic antibiotics are not suggested to reduce infectious morbidity following surgery for a missed or incomplete Abortion (I-E).
- 11Antibiotic prophylaxis is not recommended for insertion of an intrauterine device (I-E). However, health care professionals could consider screening for sexually transmitted infections in high-risk populations (III-C).
- 12There is insufficient evidence to support the use of antibiotic prophylaxis for an endometrial biopsy (III-L).
- 13The best method to prevent infection after hysterosalpingography is unknown. Women with dilated tubes found at the time of hysterosalpingography are at highest risk, and prophylactic antibiotics (e.g., doxycycline) should be given (II-3B).
- 14Antibiotic prophylaxis is not recommended for urodynamic studies in women at low risk, unless the incidence of urinary tract infection post-urodynamics is > 10% (1-E).
- 15In patients with morbid obesity (BMI > 35 kg/m2), doubling the antibiotic dose may be considered (III-B).
- 16Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary procedure (III-E).
Key Words
Abbreviations:
BV (bacterial vaginosis), HSG (hysterosalpingography), PID (pelvic inflammatory disease), STI (sexually transmitted infection), UTI (urinary tract infection)To read this article in full you will need to make a payment
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Article info
Publication history
No. 275, April 2012 (Reaffirmed October 2018)
Footnotes
This document reflects emerging clinical and scientific advances on the date issued, and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well-documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
Women have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice women should be provided with information and support that is evidence based, culturally appropriate and tailored to their needs. The values, beliefs and individual needs of each woman and her family should be sought and the final decision about the care and treatment options chosen by the woman should be respected.
Identification
Copyright
© 2018 Published by Elsevier Inc. on behalf of Society of Obstetricians and Gynaecologists of Canada.
