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.
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.


OBJECTIVE
To evaluate whether preoperative treatment with clindamycin cream might reduce the signs of post-abortion infection after legal abortion.


METHODS
Prospective, double-blinded, placebo-controlled, multicenter study.


METHODS
Consecutive women attending for surgical termination prior to 11+4 gestational weeks were approached. We randomized participants to preoperative vaginal treatment with 2% clindamycin cream or placebo cream in a double-blinded fashion. At all visits vaginal smears were air dried on microscopy slides to be stored. The rate of postoperative pelvic infection according to our definition was the main outcome variable, the cure rates of BV and of intermediate flora were secondary outcome variables.


RESULTS
Of 1655 enrolled women, 1102 were evaluable for analyses. Fifty-eight women developed signs of post-abortion infection. Preoperative treatment with clindamycin cream significantly (RR: 4.2, 95% C.I. 1.2-15.9) reduced the risk of post-abortion infection among women with abnormal vaginal flora (BV and intermediate flora). Treatment with clindamycin cream in women with normal lactobacilli flora did not demonstrate any difference compared to the non-treatment group.


CONCLUSIONS
Preoperative treatment for at least three days with clindamycin cream significantly reduced the risk for developing signs of post-abortion infection only among women with preoperative abnormal vaginal flora (BV and intermediate flora).
Larsson
P G
PG
Department of Obstetrics and Gynaecology at the Central Hospital of Skövde, Sweden.
Platz-Christensen
J J
JJ
Dalaker
K
K
Eriksson
K
K
Fåhraeus
L
L
Irminger
K
K
Jerve
F
F
Stray-Pedersen
B
B
Wölner-Hanssen
P
P
D000028:Abortion, Induced / Q000009:adverse effects*; D000287:Administration, Topical; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control*; D002981:Clindamycin / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000382:microbiology / Q000517:prevention & control*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D014621:Vagina / Q000187:drug effects / Q000382:microbiology / Q000473:pathology; D016585:Vaginosis, Bacterial / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology
D000900:Anti-Bacterial Agents; D002981:Clindamycin