Antibiotic prophylaxis for selected gynecologic surgeries.

BACKGROUND

Antibiotic prophylaxis for surgery is commonly used and is recommended by multiple organizations.

OBJECTIVE

To critically review gynecology-specific data regarding surgical antibiotic prophylaxis in selected benign gynecologic surgeries.

SEARCH STRATEGY

MEDLINE and Cochrane databases were searched from inception to July 2010.

SELECTION CRITERIA

Randomized controlled trials of benign vaginal, cervical, transcervical, abdominal, or laparoscopic procedures other than hysterectomy comparing prophylactic antibiotic use with placebo or with another antibiotic. Outcomes of interest were postoperative infections, additional treatments, and adverse events.

DATA COLLECTION AND ANALYSIS

In total, 19 trials met the inclusion criteria. Studies were individually assessed for methodologic quality, then grouped by procedure and evaluated for evidence quality.

MAIN RESULTS

There was no difference in infectious outcome for loop electrosurgical excision, hysteroscopic ablation, or laparoscopy, although evidence quality was poor. Fair evidence supports antibiotic prophylaxis for suction curettage or laparotomy. There were insufficient data regarding vaginal surgery prophylaxis.

CONCLUSION

Antibiotic prophylaxis may be beneficial in first-trimester suction curettage and laparotomy. No advantage was found for loop electrosurgical excision, hysteroscopy, or laparoscopic gynecologic surgery. Newer procedures and vaginal surgery lack research and merit study.