Do routine antibiotics after loop diathermy excision reduce morbidity?



We read the article by Foden-Schroff et al. (Vol 105, September 1998)1 with interest. However, we feel that although it addresses an important clinical problem, the conclusion that ‘routine antibiotic prophylaxis after loop diathermy excision is not justified’ is not borne out by the results of their study for several reasons. To begin with, they consider only one outcome measure: amount of vaginal loss, which is an indirect measure of infectious morbidity. Other more direct indicators such as fever, offensive discharge and pelvic pain do not appear to have been assessed. In their description of the method, the authors state that the women in their study were asked to note any adverse effects that occurred during the study period. It may have been more useful to also address specific symptoms relating to infectious morbidity or to compare vaginal flora pre- and post-treatment.

Only one antibiotic was considered, and although the authors effectively justified their choice, a different antibiotic or a combination of antibiotics may have altered the outcome. Topical antibiotics may be associated with fewer systemic side effects than oral antibiotics. It is also important to note that their results apply to their population who have a 10% prevalence of Chlamydia trachomatis. The same results may not be extrapolated to other areas, such as inner city London, where the prevalence of sexually transmitted infection in women of reproductive age may be significantly higher.

We therefore feel that the only conclusion that the authors can reach from their study is that the oral administration of their chosen antibiotic does not lead to a reduction in vaginal loss after loop diathermy excision of the cervix. To conclude from the observations that ‘the routine use of antibiotics is not justified’ is we feel an over-statement of the results.