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Evidence summaries

Antibiotic Prophylaxis for Intrauterine Contraceptive Device Insertion

Use of either doxycycline 200 mg or azithromycin 500 mg by mouth before IUD insertion appears to confer modest benefit in populations with a high prevalence of sexually transmitted diseases. Level of evidence: "B"

Four trials, two from Africa (n=1485 and 1813), one from Turkey, and one from Los Angeles (n=1867), were included in a Cochrane review [Abstract] 1. The odds ratio 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 to 1.51). Use of prophylaxis was associated with a small reduction in unscheduled visits to the provider (OR 0.82; 95% CI 0.70 to 0.98). These benefits were mainly drawn from a Kenyan trial, where the prevalence of gonorrhea and chlamydial infection was high. 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 to 1.63). The risk of infection following IUD insertion was low in all studies.

Comment: The quality of evidence is downgraded by inconsistency of results; heterogeneity of results in different populations.

References

  • Grimes DA, Schulz KF. Antibiotic prophylaxis for intrauterine contraceptive device insertion. Cochrane Database Syst Rev 2001;(2):CD001327 [Review content assessed as up-to-date: 28 March 2012]. [PubMed]

Primary/Secondary Keywords