tetracycline and Abortion--Incomplete

A randomised controlled trial involving 140 non-septic incomplete abortions was performed to determine the efficacy of prophylactic tetracycline as practiced in these cases in Harare Central Hospital. The treatment group (62) received tetracycline (500 mg four times daily) for a week. The remainder acted as controls. No significant difference in sepsis rate between treatment and control groups was noted. The high sepsis recorded in the treatment group was thought to be due to poor compliance. A new prophylaxis regimen has been suggested.. The purpose of this randomized, controlled study was to determine the efficacy of tetracycline as a prophylactic antibiotic therapy in treating nonseptic, incomplete abortion patients in Zimbabwe. In 1984, the gynecology emergency unit of Harare Central Hospital admitted 3240 cases of incomplete abortion, of which 2891 were nonseptic on admission. For this prospective study, patients presenting with nonseptic, incomplete abortion (n = 140) from February through May 1985 were recruited at Harare Central. These patients were randomly divided into treatment and control groups, and all patients received aseptic evacuation procedures. Following evacuation, the treatment group (n = 62) was given tetracycline (500 mg 4 times daily to be taken for a week). The remainder (n = 78) acted as controls. Diagnosis for sepsis, based on defined parameters, was performed a week later by the author, who did not know the group to which the patient belonged. The majority of the patients in both groups were 15-24 years old and of parity 1-4. An overall sepsis rate of 35.6% was obtained in this study. No significant difference in sepsis rates between treatment and control groups was noted. The apparent higher proportion of sepsis recorded in the treatment group (25/62, or 40.32%) in comparison to the control group (23/78, or 29.5%) was not significant. Although all patients insisted they took their drugs as instructed, further questioning and counting of remaining capsules revealed that the majority (82.6%) had not taken any or part of the course; the patients who did complete the course had not followed the instructions properly. Thus, the lack of significant reduction in the sepsis rate with the use of prophylactic tetracycline was thought to be due to poor compliance. The author argued that this was due to the young age, low socioeconomic status, and lack of understanding of the regimen among the patients. Thus, it is suggested that tetracycline treatment be replaced with a cheap, single-dose, hospital-administered prophylaxis regimen, such as doxycycline, that covers a wide range of organisms.

Topics: Abortion, Incomplete; Adolescent; Adult; Clinical Trials as Topic; Female; Humans; Pregnancy; Sepsis; Tetracycline; Zimbabwe