Abstract

PIP: This review first makes some general comments about prophylactic antibiotics: animal models for antimicrobial prophylaxis, bacterial flora of the female genital tract, timing and duration of prophylactic antibiotic administration, and drug of choice for prophylaxis. Subsequent sections cover the following: prophylaxis for bacterial endocarditis; prophylaxis for vaginal hysterectomy; prophylaxis for elective abortions; prophylaxis for infertility and reconstructive surgery; prophylaxis for cesarean section (risk factor for postoperative infection, antibiotic of choice, timing of administration, duration of administration, and alternatives ot systemic prophylactic antibiotics); prophylactic antibiotics and cervical cerclage; and prophylaxis for preterm rupture of membranes. The recommendations are preceded by a description of the various categories suggested by the Centers for Disease Control, which recognizes that some recommendations are more firmly based on objective data than others: category 1 -- strongly recommended for adoption; category 2, moderately recommended for adoption; and category 3, weakly recommended for adoption. The recommendations include the following: all patients with a prosthetic cardiac valve should receive antibiotic prophylaxis for endometrial biopsy, insertion of IUD, urethral catheterization, dilation and curettage, hysterectomy, normal vaginal delivery, cesarean section, and sigmoidoscopy (category 1); premenopausal patients undergoing vaginal hysterectomy , with or without vaginal repair, should receive prophylactic antibiotics (category 1); and postmenopausal patients, with or without estrogen replacement therapy, may receive prophylaxis (category 2); regarding abdominal hysterectomy, patients with valvular heart disease, low socioeconomic status, cervical conization preceding hysterectomy from 2-21 days, or underlying conditions making a prolonged or difficult operation likely may benefit from prophylaxis (category 2); for elective abortion, patients with valvular heart disease, or a history of acute salpingitis may benefit from prophylaxis (category 2); patients undergoing surgical management of infertility secondary to endometriosis, pelvic adhesions, or distorted tubal architecture may benefit from prophylaxis; and regarding cesarean section, indigent or medically compromised patients with rupture of membranes over 8 hours and labor only 12 hours should receive prophylaxis (category 1).