Antibiotic prophylaxis for hysteroscopy evaluation of the uterine cavity





Literature Review Article

 Antibiotic prophylaxis for hysteroscopy evaluation of the uterine cavity. Kasius, J., Broekmans, F., Fauser, B., Devroey, P., Fatemi, H. Fertility & Sterility. 2011 February; 95 (2): 792-4. 

Dr. John Preston Parry, M.D., M.P.H.

The question addressed in this article was whether antibiotic prophylaxis would decrease the risk of infection from office hysteroscopy in asymptomatic infertility patients who had a normal transvaginal ultrasound. The authors describe the study as pseudorandomized, but more precisely the selection process can be characterized as prospective documentation of exposure (to antibiotic or not) based solely on which hospital the patient attended. All patients had povidone-iodine cleansing of the vagina prior to hysteroscopy regardless of assigned treatment arm. 631 patients were enrolled, 266 received antibiotic prophylaxis, 365 did not, and there was a single infection, which occurred in one of the patients receiving prophylaxis. Accordingly, the authors conclude that given the low rate of infection and inadequate evidence to suggest benefit from prophylaxis, antibiotics should not be routinely used in asymptomatic infertility patients undergoing office hysteroscopy if they have a normal transvaginal ultrasound.

Dr. Daniel Williams, M.D.

The results of this study are consistent with larger studies that have shown no benefit of prophylactic antibiotics in patients undergoing office hysteroscopy.  As would be expected, betadine preparation of the cervix should be sufficient.  With such a low incidence of infection, it would take extremely large patient numbers to have adequate power (not mentioned in this study) to eliminate B error.  Therefore, the usefulness of additional studies on this question is doubtful.  

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.



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