A new large-scale international trial led by the University of Birmingham in the UK explored whether antibiotics can avoid the surgical complication of a potentially fatal pelvic infection and could help shape international guidelines and policy practice.
The trial involved thousands of women at hospitals across four low- and middle-income countries. It found that giving antibiotics prior to miscarriage surgery did not result in a significant reduction in pelvic infection within 14 days post-surgery if clinical judgement was used to determine if there was an infection or not, but that when the strict international definition of pelvic infection was used then antibiotics were beneficial.
Despite the procedure being relatively common, prior to this trial there was little information to guide practice and the trial has provided high-quality evidence for practitioners and policymakers. The research was funded by MRC, Wellcome Trust, and UK Aid, and was led by researchers at the Institute of Metabolism and Systems Research, the Institute of Applied Health Research, and the Health Economics Unit at the University of Birmingham. The study was published in the New England Journal of Medicine.
“The question of whether to use antibiotics is particularly important in low- and middle-income countries. Rates of surgery for miscarriage are high, owing to low uptake of non-surgical management approaches, infections are more common following surgery in these countries versus higher resource countries, and access to resources to care for women who do develop complications is poor,” said lead author Dr David Lissauer of the University of Birmingham. “Before the AIMS trial we had no idea what the right thing was to reduce the serious complication of pelvic infection. We finally now have the highest quality evidence that a single, cheap, preventative dose of two commonly available antibiotics was not only safe, but also appeared to reduce pelvic infection if the infection was diagnosed using strict international criteria.”