Are antibiotics needed before a dilation and curettage (D&C)?

Prophylactic Antibiotics for Dilation and Curettage

Prophylactic antibiotics are not routinely recommended before dilation and curettage (D&C) procedures for most patients. 1

Evidence Assessment

The available guidelines and research provide clear direction on this question:

• The French Society of Anesthesia and Intensive Care Medicine explicitly states that for intrauterine procedures like curettage, the very low risk of infection (<1%) and lack of compelling evidence do not justify systematic antibiotic prophylaxis 1.

• A prospective study found only a 5% incidence of bacteremia during D&C procedures, placing it in the same low-risk category as other diagnostic procedures 2.

• A randomized, double-blind study of 289 women undergoing curettage for incomplete abortion showed no significant benefit from prophylactic doxycycline in preventing pelvic infection (p = 0.22) 3.

• Another study of 67 women with metrorrhagia found no statistically significant difference in PID rates between those who received post-procedure antibiotics and those who did not 4.

Specific Clinical Scenarios

Standard D&C Procedures

For routine D&C procedures in patients without risk factors:

• No prophylactic antibiotics are needed
• The risk of infection is very low (<1%) 1
• Bacteremia rates are approximately 5%, similar to other low-risk procedures 2

Special Circumstances Where Antibiotics May Be Considered

Prophylactic antibiotics may be warranted in specific high-risk situations:

• Patients with prosthetic heart valves 2
• Cases of septic abortion 2
• Immunocompromised patients (case-by-case basis) 1
• Patients with a history of pelvic inflammatory disease

Potential Risks of Unnecessary Antibiotic Use

Using antibiotics when not indicated carries several risks:

• Development of bacterial resistance 1
• Allergic reactions including anaphylaxis 5
• Increased healthcare costs 5
• Disruption of normal flora

Common Pitfalls

1. Overuse of antibiotics: Many clinicians prescribe antibiotics "just to be safe" despite evidence showing no benefit for routine D&C procedures.

2. Confusing D&C with other procedures: Unlike ERCP or biliary procedures where prophylactic antibiotics are recommended 1, D&C has a much lower infection risk.

3. Failure to distinguish between therapeutic and prophylactic use: Antibiotics are appropriate for treating established infections but not for routine prophylaxis in D&C.

The evidence clearly supports that for most patients undergoing D&C, the risks of antibiotic prophylaxis outweigh the benefits, and routine use is not recommended.