Prophylactic antibiotics for intrauterine device insertion: a metaanalysis of the randomized controlled trials

Abstract

We evaluated the effectiveness of prophylactic antibiotic administration before IUD insertion in reducing the incidence of pelvic inflammatory disease, unscheduled visits back to the clinician, and IUD discontinuations within 3 months of insertion. We performed a metaanalysis of all known randomized controlled trials comparing an antibiotic (either oral doxycycline or azithromycin) versus a placebo or no treatment. Use of prophylaxis significantly reduced the frequency of unscheduled return visits (odds ratio 0.82; 95% CI 0.70, 0.98). The protection against pelvic inflammatory disease was smaller and not statistically significant 0.89 (95% CI 0.53, 1.51). No significant effect on premature IUD discontinuation was evident. Use of either doxycycline or azithromycin before IUD insertion offered little observable benefit in the US. Prophylaxis reduced unscheduled visits and possibly PID in developing countries, which have higher rates of sexually transmitted diseases than in the US. A more important finding in these trials is the low incidence of pelvic inflammatory disease with or without prophylactic antibiotics.

PIP: This meta-analysis of randomized controlled trials compared an antibiotic prophylaxis (either oral doxycycline or azithromycin) with placebo or no treatment on risk of pelvic inflammatory disease (PID), incidence of unscheduled return visits to the clinician, and IUD discontinuation within 3 months of insertion. The analysis demonstrated that the use of prophylaxis significantly reduced the frequency of unscheduled return visits. The protection against PID was smaller and was not statistically significant. Furthermore, the analysis showed that no significant effect on premature IUD discontinuation was evident. Use of either oral doxycycline or azithromycin before IUD insertion offered little observable benefit in the US. Prophylaxis reduces unscheduled visits and possibly PID in developing countries, where rates of sexually transmitted diseases are higher compared to the US. A more important finding in these trials was the low incidence of PID with or without prophylactic antibiotics.