From the Guidelines
Doxycycline should be administered orally 1 hour before the suction dilation and curettage (D&C) procedure for incomplete abortion, as this route is commonly used and effective in providing prophylaxis against common vaginal and cervical pathogens. When considering antibiotic prophylaxis for a patient undergoing D&C for incomplete abortion, it's essential to weigh the risks and benefits, particularly in the context of preventing post-operative infectious complications, such as endometritis and pelvic inflammatory disease (PID) 1. The choice of antibiotic and route of administration should be guided by the need to cover common pathogens that may be present in the vaginal and cervical flora. Some key points to consider in the management of such cases include:
- The risk of post-operative infection is relatively low in most patients undergoing uncomplicated D&C for incomplete abortion
- Patients with certain risk factors, such as a history of PID, multiple sexual partners, or residing in areas with high prevalence of sexually transmitted infections, may benefit from prophylaxis
- The use of broad-spectrum antibiotics, such as doxycycline, can help reduce the risk of infection by covering a wide range of potential pathogens
- Oral administration of doxycycline is a common and effective route for prophylaxis in this setting, although intravenous options are also available for patients who may not be able to tolerate oral medications. In clinical practice, a single dose of doxycycline 200 mg orally one hour before the procedure is a reasonable choice for prophylaxis in patients undergoing D&C for incomplete abortion, particularly when individual risk factors are present.
From the Research
Recommended Antibiotic Prophylaxis for Suction Dilation and Curettage (D&C)
- The American College of Obstetricians and Gynecologists (ACOG) recommends antibiotic prophylaxis for patients undergoing suction D&C for incomplete abortion, but does not specify the route of administration for doxycycline 2.
- Studies have investigated the efficacy of oral doxycycline in preventing pelvic infection after curettage for spontaneous (incomplete) abortion, with mixed results 3, 4, 5.
- One study found that prophylactic doxycycline is not effective in preventing pelvic infection after curettage for spontaneous (incomplete) abortion 3.
- Another study found that the incidence of major complications and total complications was significantly reduced in the group receiving doxycycline as prophylactic antibiotic coverage for elective first trimester abortion 4.
- A study comparing two dosing regimens of doxycycline found that taking doxycycline the night prior to surgery may result in adequate absorption with better tolerance, but results in lower serum levels at the time of D&E 6.
Administration of Doxycycline
- The studies suggest that oral doxycycline can be given 30-60 minutes prior to the procedure 3, or up to 12 hours before the procedure 2.
- One study found that giving doxycycline with food on the night prior to D&E results in less emesis and nausea, but results in lower serum levels at the time of D&E 6.
- The optimal timing and route of administration for doxycycline prophylaxis for suction D&C are not clearly established, and may depend on individual patient factors and clinical judgment 2.
Guidelines and Recommendations
- The Society of Family Planning recommends the routine use of antibiotic prophylaxis, preferably with doxycycline, before surgical abortion 2.
- The guidelines suggest that perioperative oral doxycycline given up to 12 hours before a surgical abortion appears to effectively reduce infectious risk 2.
- The presence of Chlamydia trachomatis, Neisseria gonorrhoeae, or acute cervicitis carries a significant risk of upper genital tract infection, and antibiotic prophylaxis is recommended in these cases 2, 5.