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. 2016 Feb 23;34(4):382–391. doi: 10.1016/S1701-2163(16)35222-7

Antibiotic Prophylaxis in Gynaecologic Procedures

Nancy Van Eyk 1, Julie van Schalkwyk 2; INFECTIOUS DISEASES COMMITTEE
PMCID: PMC7128769  PMID: 22472341

Abstract

Objective

To review the evidence and provide recommendations on antibiotic prophylaxis for gynaecologic procedures.

Outcomes

Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in gynaecologic procedures.

Evidence

Medline and The Cochrane Library were searched for articles published between January 1978 and January 2011 on the topic of antibiotic prophylaxis in gynaecologic procedures. Results were restricted to systematic reviews, randomized control trials/ controlled clinical trials, and observational studies. Searches were updated on a regular basis and incorporated in the guideline to June 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Values

The quality of evidence obtained was rated using the criteria described in the Report of the Canadian Task Force on Preventative Health Care (Table 1).

Benefits, harms, and costs

Guideline implementation should result in a reduction of cost and related harm of administering antibiotics when not required and a reduction of infection and related morbidities when antibiotics have demonstrated a proven benefit.

Recommendations

  • 1.

    All women undergoing an abdominal or vaginal hysterectomy should receive antibiotic prophylaxis. (I-A)

  • 2.

    All women undergoing laparoscopic hysterectomy or laparoscopically assisted vaginal hysterectomy should receive prophylactic antibiotics. (III-B)

  • 3.

    The choice of antibiotic for hysterectomy should be a single dose of a first-generation cephalosporin. If patients are allergic to cephalosporin, then clindamycin, erythromycin, or metronidazole should be used. (I-A)

  • 4.

    Prophylactic antibiotics should be administered 15 to 60 minutes prior to skin incision. No additional doses are recommended. (I-A)

  • 5.

    If an open abdominal procedure is lengthy (e.g., > 3 hours), or if the estimated blood loss is > 1500 mL, an additional dose of the prophylactic antibiotic may be given 3 to 4 hours after the initial dose. (III-C)

  • 6.

    Antibiotic prophylaxis is not recommended for laparoscopic procedures that involve no direct access from the abdominal cavity to the uterine cavity or vagina. (l-E)

  • 7.

    All women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence should receive a single dose of firstgeneration cephalosporin. (III-B)

  • 8.

    Antibiotic prophylaxis is not recommended for hysteroscopic surgery. (II-2D)

  • 9.

    All women undergoing an induced (therapeutic) surgical abortion should receive prophylactic antibiotics to reduce the risk of postabortal infection. (I-A)

  • 10.

    Prophylactic antibiotics are not suggested to reduce infectious morbidity following surgery for a missed or incomplete abortion. (I-E)

  • 11.

    Antibiotic prophylaxis is not recommended for insertion of an intrauterine device. (I-E) However, health care professionals could consider screening for sexually transmitted infections in high-risk populations. (III-C)

  • 12.

    There is insufficient evidence to support the use of antibiotic prophylaxis for an endometrial biopsy. (III-L)

  • 13.

    The best method to prevent infection after hysterosalpingography is unknown. Women with dilated tubes found at the time of hysterosalpingography are at highest risk, and prophylactic antibiotics (e.g., doxycycline) should be given. (II-3B)

  • 14.

    Antibiotic prophylaxis is not recommended for urodynamic studies in women at low risk, unless the incidence of urinary tract infection post-urodynamics is > 10%. (1-E)

  • 15.

    In patients with morbid obesity (BMI > 35 kg/m2), doubling the antibiotic dose may be considered. (III-B)

  • 16

    Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary procedure. (III-E)

Key Words: Antibiotics, prophylaxis, hysterectomy, hysteroscopy, gynaecologic surgery

ABBREVIATIONS: BV bacterial vaginosis, HSG hysterosalpingography, PID pelvic inflammatory disease, STI sexually transmitted infection, UTI urinary tract infection

Footnotes

This clinical practice guideline has been prepared by the Infectious Diseases Committee, reviewed by the Family Physician Advisory Committee, and approved by the Executive and Council of the Society of Obstetricians andGynaecologists of Canada. Disclosure statements have been received from all members of the committee.

Disclosure statements have been received from all members of the committee. The literature searches and bibliographic support for this guideline were undertaken by Becky Skidmore, Medical Research Analyst, Society of Obstetricians and Gynaecologists of Canada

The literature searches and bibliographic support for this guideline were undertaken by Becky Skidmore, Medical Research Analyst, Society of Obstetricians and Gynaecologists of Canada

This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the SOGC.

Contributor Information

INFECTIOUS DISEASES COMMITTEE:

Mark H. Yudin, Victoria M. Allen, Céline Bouchard, Marc Boucher, Sheila Caddy, Eliana Castillo, Deborah M. Money, Kellie E. Murphy, Gina Ogilvie, Caroline Paquet, Julie van Schalkwyk, and Vyta Senikas

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