@article { , title = {A Randomized Trial of Prophylactic Antibiotics for Miscarriage Surgery}, abstract = {© 2019 Massachusetts Medical Society. BACKGROUND Surgical intervention is needed in some cases of spontaneous abortion to remove retained products of conception. Antibiotic prophylaxis may reduce the risk of pelvic infection, which is an important complication of this surgery, particularly in low-resource countries. METHODS We conducted a double-blind, placebo-controlled, randomized trial investigating whether antibiotic prophylaxis before surgery to complete a spontaneous abortion would reduce pelvic infection among women and adolescents in low-resource countries. We randomly assigned patients to a single preoperative dose of 400 mg of oral doxycycline and 400 mg of oral metronidazole or identical placebos. The primary outcome was pelvic infection within 14 days after surgery. Pelvic infection was defined by the presence of two or more of four clinical features (purulent vaginal discharge, pyrexia, uterine tenderness, and leukocytosis) or by the presence of one of these features and the clinically identified need to administer antibiotics. The definition of pelvic infection was changed before the unblinding of the data; the original strict definition was two or more of the clinical features, without reference to the administration of antibiotics. RESULTS We enrolled 3412 patients in Malawi, Pakistan, Tanzania, and Uganda. A total of 1705 patients were assigned to receive antibiotics and 1707 to receive placebo. The risk of pelvic infection was 4.1\% (68 of 1676 pregnancies) in the antibiotics group and 5.3\% (90 of 1684 pregnancies) in the placebo group (risk ratio, 0.77; 95\% confidence interval [CI], 0.56 to 1.04; P=0.09). Pelvic infection according to original strict criteria was diagnosed in 1.5\% (26 of 1700 pregnancies) and 2.6\% (44 of 1704 pregnancies), respectively (risk ratio, 0.60; 95\% CI, 0.37 to 0.96). There were no significant between-group differences in adverse events. CONCLUSIONS Antibiotic prophylaxis before miscarriage surgery did not result in a significantly lower risk of pelvic infection, as defined by pragmatic broad criteria, than placebo.}, doi = {10.1056/NEJMoa1808817}, eissn = {1533-4406}, issn = {0028-4793}, issue = {11}, journal = {New England Journal of Medicine}, pages = {1012-1021}, publicationstatus = {Published}, publisher = {Massachusetts Medical Society}, url = {https://nottingham-repository.worktribe.com/output/1751457}, volume = {380}, keyword = {General medicine}, year = {2019}, author = {Lissauer, David and Wilson, Amie and Hewitt, Catherine A. and Middleton, Lee and Bishop, Jonathan R.B. and Daniels, Jane and Merriel, Abi and Weeks, Andrew and Mhango, Chi Sale and Mataya, Ronald and Taulo, Frank and Ngalawesa, Theresa and Chirwa, Agatha and Mphasa, Colleta and Tambala, Tayamika and Chiudzu, Grace and Mwalwanda, Caroline and Mboma, Agnes and Qureshi, Rahat and Ahmed, Iffat and Ismail, Humera and Oladapo, Olufemi T. and Mbaruku, Godfrey and Chibwana, Jerome and Watts, Grace and Simon, Beatus and Ditai, James and Tom, Charles Otim and Acam, Jane Frances and Ekunait, John and Unzia, Hellen and Iyaku, Margaret and Makiika, Joshua J. and Zamora, Javier and Roberts, Tracy and Goranitis, Ilias and Bar-Zeev, Sarah and Desmond, Nicola and Arulkumaran, Sabaratnam and Bhutta, Zulfiqar A. and Gulmezoglu, Ahmet M. and Coomarasamy, Arri} }