Antibiotic Prophylaxis for Dilation and Curettage
Preoperative antibiotic prophylaxis is not necessary for routine dilation and curettage (D&C) procedures due to the very low risk of infection. 1
Rationale for Not Using Prophylactic Antibiotics in D&C
- D&C is considered a clean or clean-contaminated procedure with a low risk of infection (<1%), which does not justify systematic antibiotic prophylaxis 1
- The 2019 French Society of Anesthesia and Intensive Care Medicine (SFAR) guidelines specifically state that for intrauterine procedures such as endometrial biopsy and curettage, antibiotic prophylaxis is not recommended 1
- Research has shown only a 5% incidence of transient bacteremia during D&C procedures, placing it in the same low-risk category as other diagnostic procedures 2
Special Circumstances Where Prophylaxis May Be Considered
- Septic abortion (active infection already present) 2
- Patients with prosthetic heart valves 2
- Patients with significant immunocompromise 3
- High-risk patients with multiple comorbidities that increase infection risk 1
Evidence Against Routine Prophylaxis
- A follow-up study of women undergoing D&C for metrorrhagia found no statistically significant difference in rates of pelvic inflammatory disease between those who received antibiotics and those who did not 4
- Unnecessary antibiotic use can lead to adverse reactions, development of bacterial resistance, and increased healthcare costs 3
General Principles of Antibiotic Prophylaxis When Required
If prophylaxis is deemed necessary in special circumstances:
- Antibiotics should be administered within 60 minutes before the skin incision 1, 5
- A single dose is typically sufficient for short procedures like D&C 1
- The antibiotic selected should cover the most likely pathogens (typically vaginal flora) 1
Common Pitfalls to Avoid
- Administering antibiotics too early (>2 hours before procedure) or too late (after procedure) significantly reduces effectiveness in preventing infections 5
- Continuing antibiotics beyond the perioperative period for prophylaxis provides no additional benefit and increases risk of adverse effects 1
- Failing to distinguish between prophylaxis (prevention) and treatment (active infection already present) 1
In conclusion, while antibiotic prophylaxis plays an important role in many surgical procedures, routine D&C does not warrant prophylactic antibiotics except in specific high-risk situations 1.