The quality of evidence (I-III) and classification of recommendations (A-L) are defined at the end of the "Major Recommendations."
- All women undergoing an abdominal or vaginal hysterectomy should receive antibiotic prophylaxis. (I-A)
- All women undergoing laparoscopic hysterectomy or laparoscopically assisted vaginal hysterectomy should receive prophylactic antibiotics. (III-B)
- The choice of antibiotic for hysterectomy should be a single dose of a first-generation cephalosporin. If patients are allergic to cephalosporin, then clindamycin, erythromycin, or metronidazole should be used. (I-A)
- Prophylactic antibiotics should be administered 15 to 60 minutes prior to skin incision. No additional doses are recommended. (I-A)
- If an open abdominal procedure is lengthy (e.g., >3 hours), or if the estimated blood loss is >1500 mL, an additional dose of the prophylactic antibiotic may be given 3 to 4 hours after the initial dose. (III-C)
- Antibiotic prophylaxis is not recommended for laparoscopic procedures that involve no direct access from the abdominal cavity to the uterine cavity or vagina. (I-E)
Surgery for Pelvic Organ Prolapse and/or Stress Urinary Incontinence
- All women undergoing surgery for pelvic organ prolapse and/or stress urinary incontinence should receive a single dose of first generation cephalosporin. (III-B)
- Antibiotic prophylaxis is not recommended for hysteroscopic surgery. (II-2D)
Induced (Therapeutic) Abortion
- All women undergoing an induced (therapeutic) surgical abortion should receive prophylactic antibiotics to reduce the risk of postabortal infection. (I-A)
Missed or Incomplete Abortion
- Prophylactic antibiotics are not suggested to reduce infectious morbidity following surgery for a missed or incomplete abortion. (I-E)
Intrauterine Device Insertion
- Antibiotic prophylaxis is not recommended for insertion of an intrauterine device. (I-E) However, health care professionals could consider screening for sexually transmitted infections in high-risk populations. (III-C)
- There is insufficient evidence to support the use of antibiotic prophylaxis for an endometrial biopsy. (III-L)
- The best method to prevent infection after hysterosalpingography is unknown. Women with dilated tubes found at the time of hysterosalpingography are at highest risk, and prophylactic antibiotics (e.g., doxycycline) should be given. (II-3B)
- Antibiotic prophylaxis is not recommended for urodynamic studies in women at low risk, unless the incidence of urinary tract infection post-urodynamics is >10%. (1-E)
Dosage Of Antibiotic Prophylaxis In Obese Patients
- In patients with morbid obesity (BMI >35 kg/m2), doubling the antibiotic dose may be considered. (III-B)
Prevention Of Infective Endocarditis
- Administration of antibiotics solely to prevent endocarditis is not recommended for patients who undergo a genitourinary procedure. (III-E)
Quality of Evidence Assessment*
I: Evidence obtained from at least one properly randomized controlled trial
II-1: Evidence from well-designed controlled trials without randomization
II-2: Evidence from well–designed cohort (prospective or retrospective) or case–control studies, preferably from more than one centre or research group
II-3: Evidence obtained from comparisons between times or places with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
*Adapted from the Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.
Classification of Recommendations†
A. There is good evidence to recommend the clinical preventive action.
B. There is fair evidence to recommend the clinical preventive action.
C. The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making.
D. There is fair evidence to recommend against the clinical preventive action.
E. There is good evidence to recommend against the clinical preventive action.
L. There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making.
†Adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care.