Antibiotics for treating septic abortion
Atim Udoh1, Emmanuel E Effa2, Olabisi Oduwole3, Babasola O Okusanya4, Obiamaka Okafo5
1. College of Medical Sciences, University of Calabar, Obstetrics and Gynaecology, Calabar, Cross River State, Nigeria
2. College of Medical Sciences, University of Calabar, Internal Medicine, Calabar, Cross River State, Nigeria
3. University of Calabar Teaching Hospital (ITDR/P), Institute of Tropical Diseases Research and Prevention, Calabar, Cross River State, Nigeria
4. Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Experimental and Maternal Medicine Unit, Department of Obstetrics and Gynaecology, Lagos, Nigeria
5. University of Calabar, Calabar, Nigeria
Udoh A, Effa EE, Oduwole O, Okusanya BO, Okafo O. Antibiotics for treating septic abortion. Cochrane Database of Systematic Reviews 2016, Issue 7. Art. No.: CD011528. DOI: 10.1002/14651858.CD011528.pub2
To read the full-text article, please click on this link: 10.1002/14651858.CD011528.pub2
Background
A septic abortion is any abortion with infection after a miscarriage or intentional pregnancy termination. One of the signs of septic abortion is fever. Antibiotic treatment is very important for the treatment of septic abortion. The recommended treatments include antibiotics that have effects on different types of bacteria. However, there is no agreement on the most effective antibiotics to be used either alone or in combination to treat septic abortion.
Trial characteristics
This review included 3 small studies of 233 women with septic abortion. One study compared clindamycin alone to penicillin plus chloramphenicol; the second study compared penicillin plus chloramphenicol to cephalothin plus kanamycin; and the third study compared tetracycline enzyme-based antibiotic with intravenous penicillin G.
Results
We found no strong evidence that clindamycin alone is better than penicillin plus chloramphenicol for treating women with septic abortion. Similarly, the available evidence did not suggest that penicillin plus chloramphenicol is better than cephalothin plus kanamycin for the treatment of women with septic abortion. Furthermore, performing D&C before starting antibiotic treatment was not better than performing D&C after antibiotic treatment has begun. The use of tetracycline-enzyme antibiotic brought women's fever down faster than intravenous penicillin G.
Conclusion
The available evidence from three small trials, which involved some antibiotics not currently in use, is insufficient to advocate for a change in existing treatment recommendations for septic abortion. In spite of this, combinations of antibiotics may be administered to women with septic abortion because they are more likely to reduce fever faster, including in women with bacteria in the blood, than single antibiotic treatment. Only one study reported harm experienced by women: two women given clindamycin had treatment failure, and one woman had an adverse drug reaction. In addition, two women in the clindamycin group had pelvic abscess compared to one in the penicillin plus chloramphenicol group, although the difference was not significant. The limitation of this review is the inclusion of three small studies conducted over 30 years ago.