title: Are antibiotics necessary after 48 hours of improvement in infected/septic abortions? A randomized controlled trial followed by a cohort study.
abstract: OBJECTIVE
  We sought to investigate whether oral antibiotics are necessary, after 48 hours of clinical improvement, in uncomplicated septic abortion.
  
  
  METHODS
  In a randomized double-blind clinical trial, 56 women with uncomplicated septic abortion were treated with intravenous antibiotics, followed by uterine evacuation. On hospital discharge (day 1), patients were randomized to receive either oral doxycycline plus metronidazole or placebo, until completing 10 days of treatment. Clinical cure was defined by the absence of fever (<37.7°C), reduced vaginal bleeding, and minimal or no pelvic pain.
  
  
  RESULTS
  Cure was observed in all 56 patients. The institutional review board stopped the treatment arm as it was adding risk with no further benefit to the patients. An observational cohort with additional 75 cases was followed up in the no treatment arm and no failure was identified (probability of an adverse event, 0%; 95% confidence interval, 0-0.03).
  
  
  CONCLUSIONS
  After 48 hours of clinical improvement, antibiotics may not be necessary.
authors.affiliation: Departamento e Serviço de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul-Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. rsavaris@hcpa.ufrgs.br
authors.forename: Ricardo F
authors.initials: RF
authors.lastname: Savaris
authors.forename: Gisele S
authors.initials: GS
authors.lastname: de Moraes
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Cristovam
authors.forename: R Daniel
authors.initials: RD
authors.lastname: Braun
mesh_terms: D000031:Abortion, Septic / Q000188:drug therapy*; D000284:Administration, Oral; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002981:Clindamycin / Q000627:therapeutic use; D015331:Cohort Studies; D004311:Double-Blind Method; D004318:Doxycycline / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D008795:Metronidazole / Q000627:therapeutic use*; D011247:Pregnancy; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D008795:Metronidazole; D002981:Clindamycin; D004318:Doxycycline