Antibiotic prophylaxis for intrauterine contraceptive device insertion (Cochrane Review)

A substantive amendment to this systematic review was last made on 08 December 2000. Cochrane reviews are regularly checked and updated if necessary.

Objectives: To assess the effectiveness of prophylactic antibiotic administration before intrauterine device (IUD) insertion in reducing IUD-related complications (pelvic inflammatory disease; complaints leading to an unscheduled visit) and discontinuations within three months of insertion.

Search strategy: We used computer searches of MEDLINE, POPLINE, and EMBASE. We also reviewed lists of references in original research and in review articles. We reviewed the reference lists of all trial reports. We wrote to experts on several continents to identify unpublished trials.

Selection criteria: We included randomized controlled trials using any antibiotic compared with a placebo.

Data collection and analysis: Data extraction: Two independent reviewers abstracted data. We made telephone calls to investigators when necessary to provide additional information. We assessed the validity of each study using methods suggested in the Cochrane Handbook. Data synthesis: We generated 2x2 tables for the principal outcome measures. The Peto modified Mantel-Haenszel technique was used to calculate odds ratios and assessed statistical heterogeneity between studies.

Main results: The odds ratios for pelvic inflammatory disease associated with use of prophylactic doxycycline or azithromycin compared with placebo or no treatment was 0.89 (95%CI 0.53-1.51). Use of prophylaxis was associated with a small reduction in unscheduled vists to the provider (OR 0.82; 95% CI 0.70-0.98). Use of doxycycline or azithromycin had little effect on the likelihood of removal of the IUD within 90 days of insertion (OR 1.05; 95% CI 0.68-1.63). No statistically significant heterogeneity between study results was detected.

Reviewers' conclusions: Use of either doxycycline 200 mg or azithromycin 500 mg by mouth before IUD insertion confers little benefit. While the reduction in unscheduled visits to the provider was marginally significant, the cost-effectiveness of routine prophylaxis remains questionable. A uniform finding in these trials was the low risk of IUD-associated infection, with or without use of antibiotic prophylaxis.

Citation: Grimes DA, Schulz FK. Antibiotic prophylaxis for intrauterine contraceptive device insertion (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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