Sawaya G F, Grady D, Kerlikowske K, Grimes D A
General Internal Medicine Section, Department of Veterans Affairs, San Francisco, California, USA.
Obstet Gynecol. 1996 May;87(5 Pt 2):884-90.
To determine the efficacy of periabortal antibiotics in preventing postabortal upper genital tract infection using data from published trials.
We performed a literature search of all studies published from January 1966 to September 1, 1994, using MEDLINE, and we manually searched bibliographies of published articles. MEDLINE search terms included: abortion, infection, prophylaxis, antibiotics, pelvic inflammatory disease (PID), and suction curettage.
Randomized, controlled trials comparing antibiotics with placebo in women undergoing suction curettage abortion before 16 weeks' gestation were identified.
TABULATION, INTEGRATION, AND RESULTS: Data were extracted independently by two reviewers, one of whom was blinded to journal, year of publication, authors, and institution. Data from 12 studies were combined using meta-analytic techniques based on a fixed-effects model. The overall summary relative risk (RR) estimate for developing postabortal upper genital tract infection in women receiving antibiotic therapy compared with those receiving placebo was 0.58 (95% confidence interval [CI] 0.47-0.71). Of high-risk women, those with a history of PID had a summary RR estimate of 0.56 (95% CI 0.37-0.84); women with a positive chlamydia culture at abortion had a summary RR estimate of 0.38 (95% CI 0.15-0.92). Of low-risk women, those with no reported history of PID had a summary RR estimate of 0.65 (95% CI 0.47-0.90); in women with a negative chlamydia culture, the summary RR estimate was 0.63 (95% CI 0.42-0.97). The lowest summary RR estimate was among women drawn from populations with a low incidence (5-6%) of postabortal infection (summary RR estimate 0.22, 95% CI 0.11-0.42). The overall 42% decreased risk of infection in women given periabortal antibiotics is similar to the risk reduction demonstrable when only studies published before 1985 are combined (summary RR estimate 0.63, 95% CI 0.44-0.89).
Our meta-analysis revealed a substantial protective effect of antibiotics in all subgroups of women undergoing therapeutic abortion, even women in low-risk groups. No more placebo-controlled trials should be performed, because women assigned to placebo are exposed to preventable risk. Routine use of periabortal antibiotics in the United States may prevent up to half of all cases of postabortal infections.
利用已发表试验的数据，确定流产后抗生素预防流产后上生殖道感染的疗效。
我们使用医学主题词表（MEDLINE）对1966年1月至1994年9月1日发表的所有研究进行了文献检索，并手动检索了已发表文章的参考文献目录。MEDLINE检索词包括：流产、感染、预防、抗生素、盆腔炎（PID）和刮宫术。
确定在妊娠16周前接受刮宫流产的女性中，将抗生素与安慰剂进行比较的随机对照试验。
制表、整合及结果：数据由两名审阅者独立提取，其中一名对期刊、发表年份、作者和机构不知情。基于固定效应模型，使用荟萃分析技术合并了12项研究的数据。与接受安慰剂的女性相比，接受抗生素治疗的女性发生流产后上生殖道感染的总体汇总相对风险（RR）估计值为0.58（95%置信区间[CI]0.47 - 0.71）。在高危女性中，有PID病史的女性汇总RR估计值为0.56（95%CI 0.37 - 0.84）；流产时衣原体培养阳性的女性汇总RR估计值为0.38（95%CI 0.15 - 0.92）。在低危女性中，无PID病史报告的女性汇总RR估计值为0.65（95%CI 0.47 - 0.90）；衣原体培养阴性的女性汇总RR估计值为0.63（95%CI 0.42 - 0.97）。汇总RR估计值最低的是来自流产后感染发生率低（5 - 6%）人群的女性（汇总RR估计值0.22，95%CI 0.11 - 0.42）。给予流产后抗生素的女性总体感染风险降低42%，与仅合并1985年前发表的研究时可证明的风险降低相似（汇总RR估计值0.63，95%CI 0.44 - 0.89）。
我们的荟萃分析显示，抗生素对所有接受治疗性流产的女性亚组都有显著的保护作用，即使是低危组女性。不应再进行安慰剂对照试验，因为被分配到安慰剂组的女性面临可预防的风险。在美国常规使用流产后抗生素可能预防高达一半的流产后感染病例。
