Prophylactic antibiotics for intrauterine device insertion: A metaanalysisof the randomized controlled trials

We evaluated the effectiveness of prophylactic antibiotic administration be fore IUD insertion in reducing the incidence of pelvic inflammatory disease , unscheduled visits back to the clinician, and IUD discontinuations within 3 months of insertion. We performed a metaanalysis of all known randomized controlled trials comparing an antibiotic (either oral doxycycline or azit hromycin) versus a placebo or no treatment. Use of prophylaxis significantl y reduced the frequency of unscheduled return visits (odds ratio 0.82; 95% CI 0.70, 0.98). The protection against pelvic inflammatory disease was smal ler and not statistically significant 0.89 (95% CI 0.53, 1.51). No signific ant effect on premature IUD discontinuation was evident. Use of either doxy cycline or azithromycin before IUD insertion offered little observable bene fit in the US. Prophylaxis reduced unscheduled visits and possibly PID in d eveloping countries, which have higher rates of sexually transmitted diseas es than in the US. A more important finding in these trials is the low inci dence of pelvic inflammatory disease with or without prophylactic antibioti cs. CONTRACEPTION 1999;60:57-63 (C) 1999 Elsevier Science Inc. All rights r eserved.