title: Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Card Antibiotic prophylaxis in abdominal hysterectomy, with special reference to the duration of the prophylaxis A randomized, double-blind, placebo-controlled comparison of the effect of nitrofurantoin monohydrate macrocrystals on the development of urinary tract infections after surgery for pelvic organ prolapse and/or stress urinary incontinence with suprapubic catheterization. Results of the National Institute of Allergy and Infectious Diseases Collaborative Clinical Trial to test the predictive value of skin testing with major and minor penicillin derivatives in hospitalized adults. Vaginal hysterectomy: cefuroxime, metronidazole or both? Does pre- and postoperative metronidazole treatment lower vaginal cuff infection rate after abdominal hysterectomy among women with bacterial vaginosis? Prophylactic Antibiotics for Suction Curettage in Incomplete Abortion Treatment with 2% clindamycin vaginal cream prior to first trimester surgical abortion to reduce signs of postoperative infection: A prospective, double‐blinded, placebo‐controlled, multicenter study Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Antibiotic prophylaxis to prevent post‐abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial A prospective study of asymptomatic bacteriuria in sexually active young women. Antimicrobial Prophylaxis in Laparotomic Gynecologic Surgery: a Prospective Randomized Study Comparing Amoxicillin-Clavulanic Acid with Cefazolin The Prophylactic Effect of Doxycycline on Postoperative Infection Rate After First‐Trimester Abortion Antibiotic prophylaxis for hysteroscopy evaluation of the uterine cavity. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. A prospective randomised study of the effects of prophylactic antibiotics on the incidence of bacteraemia following hysteroscopic surgery. Prophylactic antibiotics for suction curettage abortion: results of a clinical controlled trial. Metronidazole Prophylaxis in Elective First Trimester Abortion Placebo-controlled, double-blind, randomized study of prophylactic antibiotics in elective abdominal hysterectomy. A Randomized Trial of Prophylactic Doxycycline for Curettage in Incomplete Abortion Our patients do not need endocarditis prophylaxis for genitourinary tract procedures: insights from the 2007 American Heart Association guidelines.
abstract: BACKGROUND The purpose of this statement is to up date the recommendations by the American Heart Association ( AHA ) for the prevention of infective endocarditis that were last published in 1997 . METHODS AND RESULTS A writing group was appointed by the AHA for their expertise in prevention and treatment of infective endocarditis , with liaison members representing the American Dental Association , the Infectious Diseases Society of America , and the American Academy of Pediatrics . The writing group review ed input from national and international experts on infective endocarditis . The recommendations in this document reflect analyses of relevant literature regarding procedure-related bacteremia and infective endocarditis , in vitro susceptibility data of the most common microorganisms that cause infective endocarditis , results of prophylactic studies in animal models of experimental endocarditis , and retrospective and prospect i ve studies of prevention of infective endocarditis . MEDLINE data base search es from 1950 to 2006 were done for English- language papers using the following search terms : endocarditis , infective endocarditis , prophylaxis , prevention , antibiotic , antimicrobial , pathogens , organisms , dental , gastrointestinal , genitourinary , streptococcus , enterococcus , staphylococcus , respiratory , dental surgery , pathogenesis , vaccine , immunization , and bacteremia . The reference lists of the identified papers were also search ed . We also search ed the AHA online library . The American College of Cardiology/AHA classification of recommendations and levels of evidence for practice guidelines were used . The paper was subsequently review ed by outside experts not affiliated with the writing group and by the AHA Science Advisory and Coordinating Committee . CONCLUSIONS The major changes in the up date d recommendations include the following : ( 1 ) The Committee concluded that only an extremely small number of cases of infective endocarditis might be prevented by antibiotic prophylaxis for dental procedures even if such prophylactic therapy were 100 % effective . ( 2 ) Infective endocarditis prophylaxis for dental procedures is reasonable only for patients with underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis . ( 3 ) For patients with these underlying cardiac conditions , prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa . ( 4 ) Prophylaxis is not recommended based solely on an increased lifetime risk of acquisition of infective endocarditis . ( 5 ) Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary or gastrointestinal tract procedure . These changes are intended to define more clearly when infective endocarditis prophylaxis is or is not recommended and to provide more uniform and consistent global recommendations Two consecutive open studies were performed of the efficacy of a prophylactic cefuroxime/metronidazole combination  in abdominal hysterectomy . The first group received a 24-h regimen , the second group a  single pre-operative dose . The incidence of post-operative wound infections and urinary tract infections were similar in both groups [ wound infections in 1/75 versus 2/84 patients ( NS ) , urinary tract infections 4/75 versus 3/84 patients ( NS ) , respectively , in the 24-h group and single-dose group ] . No significant differences in other parameters , such as pyrexia and duration of post-operative hospitalization , could be detected OBJECTIVE The purpose of this study was to determine if antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals ( study drug ) after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization ( SPC ) decreases urinary tract infection ( uti ) compared with placebo in a r and omized , double-blind , multicenter trial . STUDY DESIGN Six centers participated in this study . After a negative preoperative urine culture , history , surgical and postoperative course , urine culture and symptoms at SPC removal , and at 6 to 8 weeks postoperative , any other UTI and adherence were recorded . To demonstrate a 50 % decrease in the bacteruria rate from 20 % , with 80 % power and alpha of 0.05 , 438 patients were required . Data were evaluated with Student t test and Fisher exact test . RESULTS Of 449 patients enrolled , 211 r and omized to study drug , and 224 r and omized to placebo . No pre- or perioperative differences existed between groups ( all P>.05 ) . Antibiotic prophylaxis decreased positive urine cultures compared with placebo ( 46 % vs 61 % , P=.002 ) , symptomatic UTI at SPC removal ( 7.2 % vs 19.8 % , P=.001 ) , and any other symptomatic UTI 6 to 8 weeks postoperatively ( 18.9 % vs 32.6 % , P=.002 ) . Antibiotic prophylaxis did not decrease symptomatic UTI at the 6- to 8-week postoperative visit ( 1.8 % vs 5.4 % , P=.10 ) . CONCLUSION Antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals decreases UTI compared with placebo after pelvic organ prolapse and /or urinary incontinence surgery with suprapubic catheterization BACKGROUND A history ( or lack thereof ) of penicillin allergy is known to be unreliable in predicting reactions on subsequent administration of the drug . This study tests the usefulness of four penicillin allergen skin tests in the prediction of IgE-mediated reactions subsequent to administration of penicillin . METHODS Eight centers cooperated in the National Institute of Allergy and Infectious Diseases trial of the predictive value of skin testing with major and minor penicillin derivatives .  Hospitalized adults were tested with a major determinant ( octa-benzylpenicilloyl-ocytalysine ) and a minor determinant mixture and its components ( potassium benzylpenicillin , benzylpenicilloate , and benzylpenicilloyl-N-propylamine ) . Patients then received a therapeutic course of penicillin and were observed , for 48 hours , for adverse reactions compatible with an IgE-mediated immediate or accelerated allergy . RESULTS Among 726 history-positive patients , 566 with negative skin tests received penicillin and only seven ( 1.2 % ) had possibly IgE-mediated reactions . Among 600 history-negative patients , 568 with negative skin tests received penicillin and none had a reaction . Only nine of the 167 positive skin test reactors received a penicillin agent and then usually by cautious incremental dosing . Two ( 22 % ) of these nine patients had reactions compatible with IgE-mediated immediate or accelerated penicillin allergy ; both were positive to the two determinants . CONCLUSIONS These data corroborate previous data about the negative predictive value of negative skin tests to these material s. The reaction rate in skin test-positive patients was significantly higher than in those with negative skin tests , demonstrating the positive predictive value of positive tests to both major and minor determinants . The number of patients positive only to the major determinant or only to the minor determinant mix was too small to draw conclusions about the positive predictive value of either reagent alone A r and omized double-blind prospect i ve study on the efficacy of single-dose antibiotic prophylaxis compared cefuroxime versus metronidazole versus the combination of both agents in vaginal hysterectomy . Overall antibiotic prophylaxis was effective in abscess prevention ( one abscess in 68 patients ) . In the metronidazole group a significantly higher grade of morbidity was observed : febrile morbidity 41 % versus 4 % in the two other groups ; bacteriuria 73 % versus 17 % in the cefuroxime group , versus 13 % in the combined group ; urinary tract infection 23 % , versus 0 % in the two other groups ; post-operative prescription of antibiotics 41 % , versus 0 % in the two other groups . Febrile morbidity and bacteriuria correlated positively withEscherichia coli and Proteus spp . These micro-organisms were recovered significantly more often from the vagina of patients in the metronidazole group . Cefuroxime was successful , metronidazole failed in the prevention of minor morbidity . We could not observe any effect from the addition of metronidazole to the cefuroxime prophylaxis OBJECTIVE : Bacterial vaginosis ( BV ) is a known risk factor for postoperative infection following abdominal hysterectomy . Vaginal bacterial flora scored as intermediate has been shown to have the same risk of postoperative infection as BV . METHODS : Women undergoing total abdominal hysterectomy for benign diseases were open-r and omized according to Zelen to either treatment with metronidazole rectally for at least 4 days or no treatment . At the preoperative gynecological examination a vaginal smear was collected and Gram stained . Women with BV or intermediate flora were merged to one group called abnormal vaginal flora . RESULTS : In total 213 women were r and omized to treatment or no treatment . After exclusion of 71 women , 142 women were eligible for analysis . Among the 59 women diagnosed with abnormal vaginal flora there were no vaginal cuff infections in the treated arm , compared with 27 % in the ' no treatment ' arm ( p < 0.01 ) . Treatment also reduced the vaginal cuff infection rate from 9.5 to 2 % among the 83 women with lactobacilli flora . However , this difference was not statistically significant . Treatment had no effect on the rate of wound infections . Intention-to-treat analysis showed a significant reduction in vaginal cuff infections among women r and omized to treatment . CONCLUSION : Pre- and postoperative treatment for at least 4 days with metronidazole rectally reduces significantly vaginal cuff infection among women with abnormal vaginal flora Objective : The purpose of this study was to investigate the efficacy of 200 mg of prophylactic doxycycline in preventing pelvic infection after curettage for spontaneous ( incomplete ) abortion . Methods : A r and omized , prospect i ve , double-blinded study was carried out involving 300 women with an incomplete abortion who were given either placebo or 200 mg of doxycycline orally 30–60 min prior to curettage .  A hematocrit , WBC count , pregnancy test , syphilis serology , Neisseria gonorrhoeae culture , and Micro Trak ( monoclonal antibody test , Syba , San Jose , CA ) for Chlamydia trachomatis were performed . The patients were scheduled for follow-up 2 weeks later . Antibiotic administration for any reason as well as the postoperative infection rate in these women was assessed . Results : Eleven women were excluded from analysis , leaving 289 evaluable . N. gonorrhoeae was isolated from 6 ( 2 % ) women and C. trachomatis from 8 ( 3 % ) women , and the syphilis serology was serofast in 4 ( 1 % ) women . Endometritis complicated the procedure in 4 women who received placebo and in 1 woman who received doxycycline ( P = 0.22 ) . Conclusion : Prophylactic doxycycline is not effective in preventing pelvic infection after curettage for spontaneous ( incomplete ) abortion Background . Bacterial vaginosis ( BV ) and intermediate flora is known risk‐factor for postoperative infection after surgical termination of pregnancy . Vaginal application of 2 % clindamycin cream is an efficacious treatment for BV , but it is not known whether preoperative administration of clindamycin cream might reduce the signs of post‐abortion infection after surgical termination of pregnancy HYPOTHESIS  Surgical site infections ( SSIs ) are a major contributor to patient injury , mortality , and health care costs . Despite evidence of effectiveness of antimicrobials to prevent SSIs , previous studies have demonstrated inappropriate timing , selection , and excess duration of administration of antimicrobial prophylaxis . We herein describe the use of antimicrobial prophylaxis for Medicare patients undergoing major surgery . DESIGN National retrospective cohort study with medical record review . SETTING Two thous and nine hundred sixty-five acute-care US hospitals . PATIENTS A systematic r and om sample of 34,133 Medicare in patients undergoing coronary artery bypass grafting ; other open-chest cardiac surgery ( excluding transplantation ) ; vascular surgery , including aneurysm repair , thromboendarterectomy , and vein bypass operations ; general abdominal colorectal surgery ; hip and knee total joint arthroplasty ( excluding revision surgery ) ; and abdominal and vaginal hysterectomy from January 1 through November 30 , 2001 . MAIN OUTCOME MEASURES The proportion of patients who had parenteral antimicrobial prophylaxis  initiated within 1 hour before the surgical incision ; the proportion of patients who were given a prophylactic antimicrobial agent  that was consistent with currently published guidelines ; and the proportion of patients whose antimicrobial prophylaxis was discontinued within 24 hours after surgery . RESULTS An antimicrobial dose was administered to 55.7 % ( 95 % confidence interval [ CI ] , 54.8%-56.6 % ) of patients within 1 hour before incision .  Antimicrobial agents consistent with published guidelines were administered to 92.6 % ( 95 % CI , 92.3%-92.8 % ) of the patients .  Antimicrobial prophylaxis was discontinued within 24 hours of surgery end time for only 40.7 % ( 95 % CI , 40.2%-41.2 % ) of patients . CONCLUSION Substantial opportunities exist to improve the use of prophylactic antimicrobials for patients undergoing major surgery Objective To determine the prevalence of bacterial vaginosis in women undergoing first trimester suction termination of pregnancy and to evaluate the efficacy of metronidazole in reducing the risk of post abortal pelvic infection in women with bacterial vaginosis BACKGROUND Asymptomatic bacteriuria is common in young women , but little is known about its pathogenesis , natural history , risk factors , and temporal association with symptomatic urinary tract infection . METHODS We prospect ively evaluated 796 sexually active , nonpregnant women from 18 through 40 years of age over a period of six months for the occurrence of asymptomatic bacteriuria ( defined as at least 10(5 ) colony-forming units of urinary tract pathogens per milliliter ) . The women were patients at either a university student health center or a health maintenance organization . Periodic urine cultures were taken , daily diaries were kept , and regularly scheduled interviews were performed . Escherichia coli strains were tested for hemolysin , the papG genotype , and the ribosomal RNA type . RESULTS The prevalence of asymptomatic bacteriuria ( the proportion of urine cultures with bacteriuria in asymptomatic women ) was 5 percent ( 95 percent confidence interval , 4 percent to 6 percent ) among women in the university group and 6 percent ( 95 percent confidence interval , 5 percent to 8 percent ) among women in the health-maintenance-organization group . Persistent asymptomatic bacteriuria with the same E. coli strain was rare . Symptomatic urinary tract infection developed within one week after 8 percent of occasions on which a culture showed asymptomatic bacteriuria , as compared with 1 percent of occasions when asymptomatic bacteriuria was not found ( P<0.001 ) . Asymptomatic bacteriuria was associated with the same risk factors as for symptomatic urinary tract infection , particularly the use of a diaphragm plus spermicide and sexual intercourse . CONCLUSIONS Asymptomatic bacteriuria in young women is common but rarely persists . It is a strong predictor of subsequent symptomatic urinary tract infection Abstract A prospect i ve r and omized study was conducted at the Department of Obstetrics and Gynecology , University of Bari to compare two antimicrobial regimens , amoxicillin-clavulanic acid with cefazolin as ultra-short term prophylaxis in laparotomic gynecologic surgery . Patients were r and omly allocated to receive a single dose of amoxicillin-clavulanic acid ( 2.2 g ) [ Group A ] or cefazolin ( 2 g ) [ Group B ] 30 minutes before surgery . Each patient was assessed daily until discharge for fever and the presence of infection of the surgical wound , urinary tract and respiratory tract . In the amoxicillin-clavulanic acid ( Group A ) and cefazolin ( Group B ) groups , overall 258 and 253 patients , respectively were evaluable for prophylactic efficacy at hospital discharge . Infectious complications were infrequent in both arms . Febrile morbidity occurred in 16 ( 6.3 % ) and 21 ( 8.1 % ) patients respectively in the amoxicillinclavulanic acid and cefazolin groups . Wound infection and urinary tract infection were also higher but not significantly in the cefazolin group ( 0.8 % versus 0 % and 2.7 % versus 2.0 % respectively ) . There was no respiratory tract infection or septic death in either group . It is concluded that ultra-short term prophylaxis with both amoxicillin-clavulanic acid and cefazolin is safe and effective in elective laparotomic gynecologic surgery A prospect i ve double-blind study was performed to evaluate the effect of  prophylactic antibiotic treatment before induced abortion . Eight hundred consecutive women admitted for first-trimester abortion , without signs of genital infection or antibiotic use in the last three weeks , were included in the study . Doxycycline 400 mg or placebo was given as a single oral dose ten to 12 hours before vacuum aspiration .  Ninety-one women ( 11.8 % ) returned to the hospital with suspected complications . Thirty-two of these women were diagnosed as having pelvic inflammatory disease , eight of whom ( 2.1 % ) had received doxycycline before the abortion and 24 of whom ( 6.2 % ) had received placebo , a statistically significant difference ( P < .01 ) . A history of pelvic inflammatory disease increased the risk of developing it again after an abortion OBJECTIVE To assess the prevalence of infectious complications and the protective effect of  prophylactic antibiotic treatment  after diagnostic office hysteroscopy in asymptomatic , infertile patients with normal results from transvaginal sonography . DESIGN Recording of infectious complications after routine hysteroscopy in the context of a r and omized controlled trial ; pseudor and omized , center-specific application of antibiotic prophylaxis . SETTING Two tertiary infertility care units . PATIENT(S ) Six hundred thirty-one unselected , asymptomatic , infertile women who underwent routine , diagnostic hysteroscopy prior to a first in vitro fertilization ( IVF ) or intracytoplasmic sperm injection treatment .  INTERVENTION(S ) Depending on the hospital and according to local protocol s , hysteroscopy was performed with or without antibiotic prophylaxis . MAIN OUTCOME MEASURE(S ) The prevalence of infectious complications after routine hysteroscopy .  RESULT ( S ) Of the 631 women who underwent routine , diagnostic hysteroscopy ,  antibiotic prophylaxis  was prescribed to 266 women , whereas 365 women underwent the procedure without prophylaxis . Only one infectious complication occurred ( 0.4 % ) in a patient who had not undergone therapeutic interventions and had taken antibiotic prophylaxis . This complication was successfully treated with antibiotics on an outpatient basis . CONCLUSION ( S ) Considering the extremely low risk of infectious complications and the lack of evidence , suggesting a beneficial effect of antibiotic prophylaxis , its use for routine , diagnostic office hysteroscopy should not be recommended BACKGROUND R and omized , controlled trials have shown that prophylactic antibiotics are effective in preventing surgical-wound infections . However , it is uncertain how the timing of antibiotic administration affects the risk of surgical-wound infection in actual clinical practice . METHODS We prospect ively monitored the timing of antibiotic prophylaxis and studied the occurrence of surgical-wound infections in 2847 patients undergoing elective clean or " clean-contaminated " surgical procedures at a large community hospital . The administration of antibiotics 2 to 24 hours before the surgical incision was defined as early ; that during the 2 hours before the incision , as preoperative ; that during the 3 hours after the incision , as perioperative ; and that more than 3 but less than 24 hours after the incision , as postoperative . RESULTS Of the 1708 patients who received the prophylactic antibiotics preoperatively , 10 ( 0.6 percent ) subsequently had surgical-wound infections . Of the 282 patients who received the antibiotics perioperatively , 4 ( 1.4 percent ) had such infections ( P = 0.12 ; relative risk as compared with the preoperatively treated group , 2.4 ; 95 percent confidence interval , 0.9 to 7.9 ) . Of 488 patients who received the antibiotics postoperatively , 16 ( 3.3 percent ) had wound infections ( P less than 0.0001 ; relative risk , 5.8 ; 95 percent confidence interval , 2.6 to 12.3 ) . Finally , of 369 patients who had antibiotics administered early , 14 ( 3.8 percent ) had wound infections ( P less than 0.0001 ; relative risk , 6.7 ; 95 percent confidence interval , 2.9 to 14.7 ) . Stepwise logistic-regression analysis confirmed that the administration of antibiotics in the preoperative period was associated with the lowest risk of surgical-wound infection . CONCLUSIONS We conclude that in surgical practice there is considerable variation in the timing of prophylactic administration of antibiotics and that administration in the two hours before surgery reduces the risk of wound infection OBJECTIVE To study the effect of prophylactic antibiotics on the incidence of bacteraemia following hysteroscopic surgery . DESIGN Prospect i ve r and omized study . SETTING Aberdeen Royal Infirmary . SUBJECTS One hundred and sixteen women about to undergo either endometrial laser ablation ( ELA ) or transcervical resection of the endometrium ( TCRE ) . INTERVENTION Fifty-five women were r and omised to receive 1.2 g of Augmentin ( co-amoxiclav ) i.v . at induction of anaesthesia . Sixty-one women received no antibiotic prophylaxis .  Blood cultures were obtained at the end of the surgical procedure . RESULTS Incidence of bacteraemia in the non-antibiotic group ( 16 % ) was significantly higher than that in the antibiotic group ( 2 % ) ( 95 % confidence interval for difference from 5 % to 25 % ) . The majority of organisms were of dubious clinical significance and contamination could not be excluded in 7 cases out of 10 . CONCLUSION There is no convincing evidence that antibiotics are of value in this clinical setting The prophylactic use of 300 mg doxycycline at the time of an abortion was evaluated in a r and omized controlled trial . In the group with negative chlamydia screening results , only two ( 0.4 % ) of 502 patients who received prophylactic treatment developed pelvic infection , compared with 15 ( 3.0 % ) of 497 patients who received placebos ( p = 0.001 ) . The same effectiveness was found in women with positive chlamydia screening results .  Vomiting was the major side effect of the medication and could limit its use . A simulation of selective prophylaxis in women with negative chlamydia screening results showed that its selective use in patients with a history of gonorrhea or in nulliparous women with multiple sex partners could be nearly two thirds as effective as general prophylaxis In a double-blind controlled trial , the efficacy of prophylactic metronidazole in  elective first trimester abortions  was assessed . Of 119 r and omized women , 100 followed the protocol . Fifty-one women received 400 mg metronidazole one hour before and again four and eight hours after abortion ; 49 women received a placebo . In the placebo group 20.4 % contracted postabortal genital infection compared with 3.9 % in the metronidazole group ( P<.025 ) . Of 25 women with a positive history of pelvic inflammatory disease , six contracted postabortal infection , which was a significantly increased frequency compared with women without previous episodes of pelvic inflammatory disease ( P<.05 ) . The administration of prophylaxis , however , did not significantly influence the frequency . The number of hospital days was not significantly lower in the prophylaxis group ( P>.05 ) . The total amount of metronidazole  prescribed in the study group was significantly larger than in the placebo group ( P<.05 ) , whereas the amount of  ampicillin/ pivampicillin  prescribed in the placebo group was significantly larger ( P<.05 ) . The difference between the  penicillin doses given in the treatment and placebo groups was not significant ( P>.1 ) . ( Obstet Gynecol 65:371 , 1985 To assess the efficacy of a single dose of ampicillin or cefazolin in preventing fever and infection after elective abdominal hysterectomy , we conducted a multicentre , r and omized , double-blind , controlled trial at Srinagarind Hospital , Faculty of Medicine , Khon Kaen University and Khon Kaen Regional Hospital . Three hundred and thirty patients scheduled for elective abdominal hysterectomy were r and omly allocated into either placebo , ampicillin or cefazolin groups . Patients received sterile water ( 3 mL ) or ampicillin ( 1 g ) or cefazolin ( 1 g ) intravenously according to r and om assignment 30 min before the operation . After the operation , all patients were assessed by blinded independent evaluators until discharged from the hospitals . Our main outcome measures were postoperative fever and infectious morbidity . We found that 321 patients ( 97.3 % of recruited patients ) were available for data analysis , 108 in placebo , 106 in ampicillin and 107 in cefazolin group . Febrile morbidity occurred in 13/108 ( 12.0 % ) , 14/106 ( 13.2 % ) and 12/107 ( 11.2 % ) of patients in the placebo , ampicillin and cefazolin groups , respectively . There was no statistically significant difference in febrile morbidity between the three groups . Infectious morbidity was found in 29/108 ( 26.9 % ) , 24/106 ( 22.6 % ) and 11/107 ( 10.3 % ) of patients in the placebo , ampicillin and cefazolin groups , respectively . There was a statistically significant difference between the placebo and cefazolin groups ( P = 0.002 ) . Between the placebo and ampicillin groups , the result was not significantly different ( P = 0.476 ) . There was a statistically significant difference between the cefazolin and ampicillin groups ( P = 0.015 ) . The common causes of infectious morbidity were urinary tract infection , vaginal cuff infection and surgical wound infection . We concluded that antibiotic prophylaxis by cefazolin should be recommended for elective total abdominal hysterectomy Objective To determine whether prophylactic doxycycline at suction curettage for incomplete abortion decreases the rate of postoperative pelvic infection . Methods We r and omized 240 patients to receive intravenous doxycycline or placebo at curettage . Cervical specimens for gonorrhea and chlamydia were obtained preoperatively . Two weeks post-procedure , we evaluated all patients for infectious morbidity and repeated gonorrhea and chlamydia cultures . Statistical analysis used Mann-Whitney U test , McNemar test , or Fisher exact test , as appropriate . Results There were no statistically significant differences in age , parity , gestational age , history of sexually transmitted disease , pelvic inflammatory disease , or multiple sex partners between the doxycycline and placebo groups . Preoperative gonorrhea or chlamydia isolates were positive in five ( 4.2 % ) and six ( 5 % ) of 120 doxycycline patients and four ( 3.3 % ) and eight ( 6.6 % ) of 120 controls ( not significant ) . All preoperative gonorrhea isolates remained positive postoperatively . Seven ( 5.8 % ) controls had positive postoperative chlamydia isolates , as did one ( 0.8 % ) in the doxycycline group ( P = .06 ) . We diagnosed eight ( 6.6 % ) of 120 doxycycline patients and seven ( 5.8 % ) of 120 controls with infectious morbidity ( not significant ) . Conclusion In our population of patients with incomplete abortion , the prevalence of gonorrhea and chlamydia was low , and prophylactic doxycycline did not decrease the rate of postoperative febrile morbidity The 2007 American Heart Association guidelines for the prevention of infective endocarditis have dramatically reduced both the types of eligible procedures and the types of eligible cardiac lesions that require prophylaxis . Antibiotic prophylaxis to prevent infective endocarditis is not indicated for any patient undergoing obstetric and /or gynaecological procedures , not even for patients with underlying cardiac lesions with the highest risk of developing complications from endocarditis . This sharp departure from previously published guidelines relies on the recognition that endocarditis is more likely to develop from " r and omly occurring " bacteremia ( e.g. , from brushing teeth ) than from invasive procedures and that antibiotic prophylaxis has not been proven to be effective . A short discussion on enterococcal infections associated to obstetric and gynaecological procedures and therapeutic implication s is presented
target: Benefits , harms , and costs Guideline implementation should result in a reduction of cost and related harm of administering antibiotics when not required and a reduction of infection and related morbidities when antibiotics have demonstrated a proven benefit .
background: Abstract Objective To review the evidence and provide recommendations on antibiotic prophylaxis for gynaecologic procedures .
  Outcomes Outcomes evaluated include need and effectiveness of antibiotics to prevent infections in gynaecologic procedures .