Scientific Paper Abstracts Originally Presented at the National Abortion Federation's Annual Meeting; April 23, 2007; Boston, Massachusetts

In This Article

Experience Using a Metronidazole and Azithromycin Protocol for Prophylaxis at Time of Surgical Abortion in More Than 50,000 Women

Wendy V. Norman, MD, CCFP, FCFP, DTM&H, MHSc; Sina Sakian; Supna Sandhu

Introduction and Purpose/Objectives: To prevent postoperative infections we adopted an evidence based protocol using a single observed dose of metronidazole for all women as well as azithromycin for those at high risk for infection.

Data-Collection Methods: We reviewed records at four abortion clinics in British Columbia, Canada, for the years 2001 to 2006 inclusive to extract: number of surgical abortions, follow up information, chlamydia status, risk factors for infection, and occurrence of postoperative infection. Postoperative infection was defined as antibiotic treatment by a physician for symptoms or signs of pelvic infection. High risk for infection (HR) was defined as any of the following: age 20 or less, history of STI or PID in the last 10 years, three or more sexual partners in the past year, clinical cervicitis, partner with other partners or with a history or symptoms of STI. Individual charts were reviewed to determine the proportion HR among women positive for chlamydia or with post operative infection, and to determine the overall proportion of women at each clinic who were HR.

During the period under investigation all women were treated with the following protocol: Whenever possible pretest for chlamydia, gonorrhea and bacterial vaginosis and treat as indicated prior to the day of surgical abortion. All women not pre-tested receive perioperative metronidazole (2 g orally). In addition HR women also receive azithromycin (1 g orally). All women were tested for chlamydia at the time of their procedure.

During the period under investigation all women were treated with the following protocol: Whenever possible pretest for Chlamydia, gonorrhea, and bacterial vaginosis and treat as indicated prior to the day of surgical abortion. All women not pre-tested received perioperative metronidazole (2 g. orally). In addition, HR women also receive azithromycin (1 g. orally). All women were tested for Chlamydia at the time of their procedure.

Summary of Results: 51,330 women underwent surgical abortions treated with this protocol. 40% of women met criteria for HR and thus were given azithromycin. 3.1% were chlamydia positive at the time of presentation for abortion. Follow up information was available for 27% (13,782) of all women. 0.35% of all women (180) developed postoperative infection. In low-risk women 0.52% developed infection but in the high risk population receiving both antibiotics less than a quarter as many (0.13%) women developed postoperative infections for a relative risk of 0.24. Less than 5% of those reporting infections had been treated in hospital or had laboratory testing confirming the presence of infection. The average cost in British Columbia to administer our regimen (cost of metronidazole plus 40% of the cost of azithromycin) is $3.19 CND per woman.

Conclusions: Antibiotic prophylaxis prior to surgical abortion using metronidazole for all with azithromycin for women at higher risk of infection was associated with a low (0.35%) rate of postoperative infection, even when infection is very broadly defined. The relative risk for infection in the high risk group treated in this way was less than a quarter that among those considered at low risk for infection. The average cost per woman for our regimen ($3.19 CND) compared favourably to the cost of a common alternate regimen -- a week of doxycycline ($3.12 CND) -- and carries the advantage of single observed dose treatment.

 


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