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No, most authorities do not routinely recommend it, because there is no clear evidence that prophylactic antibiotics definitely prevent pelvic inflammatory disease (PID) in IUD users and the studies so far have found only a trivial impact on PID rates due to prophylactic antibiotics. However, opinions differ and there are arguments to support both sides.
There is a theoretical rationale for the practice of giving prophylactic antibiotics. PID rates in IUD users are highest in the first few weeks and antibiotics could reduce those PID rates. While there is no statistically significant evidence of a reduction in PID rates, one study found a lower rate of IUD-related unplanned returns to the clinic.
Arguments against the use of prophylactic antibiotics include the insignificant impact of antibiotics on reducing the PID rates in IUD users demonstrated in previous studies. Also, although the rate of PID in IUD users is highest in the first few weeks after insertion, due to the long duration of use of IUDs, the greatest numbers of PID cases will occur after the first few weeks after insertion. In addition, there is some concern about the programmatic feasibility and cost of prophylactic antibiotics.
Good infection control procedures, proper assessment of the client's risk for sexually transmitted diseases (STDs), and proper insertions are very important to keep the rate of PID low in IUD clients.
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The scientific literature does not show any large advantage in reducing PID rates by giving prophylactic antibiotics for IUD insertion. However, in each of the studies, infection prevention procedures were followed and the rates of PID were very low. Also, the sample sizes in the studies were small.
Although not statistically significant, three studies all showed some reduction in the PID rate in women given prophylactic antibiotics.
Sinei et al. found that the PID rate for the first month after IUD insertion in women who were given doxycycline was 1.3% compared to 1.9% in the women who received a placebo. They also found that the women who received a placebo returned to the clinic for IUD-related problems that were suggestive of subclinical PID more often than the treated women.
Zorlu et al. found infection rates to be 2.1% and 2.9% in the doxycycline treated and the untreated women, respectively, within the first three months after IUD insertion.
Walsh et al. found that within the first three months after IUD insertion, 3.6% of the doxycycline group had the IUD removed for medical reasons compared to 4.5% of the placebo group.
- Walsh T, Bernstein G, Grimes D, Frezieres R, Bernstein L, Coulson A, et al. Effect of prophylactic antibiotics on morbidity associated with IUD insertion: results of a pilot randomized controlled trial. Contraception 1994;50:319-27.
- Sinei S, Schulz K, Lamptey P, Grimes D, Mati J, Rosenthal S, et al. Preventing IUCD-related pelvic infection. British Journal of Obstetrics and Gynaecology 1990;97:412-9.
- Zorlu C, Aral K, Cobanoglu O, Gurler S, Gokmen O. Pelvic inflammatory disease and intrauterine devices. Advances in Contraception 1993;9:299-302.
- Ladipo OA, Farr G, Otolorin E, Konje JC, Sturgen K, Cox P, et al. Prevention of IUD-related pelvic infection: the efficacy of prophylactic doxycycline at IUD insertion. Advances in Contraception 1991;7:43-54.
- Farley T, Rosenberg M, Rowe P, Chen J, Meirik O. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet 1992;339:785-8.
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