Change In Administration Method, Use Of Antibiotics In Medical Abortion Reduces Infection Rate, Study Finds

Main Category: Abortion
Also Included In: Infectious Diseases / Bacteria / Viruses
Article Date: 10 Jul 2009 - 4:00 PDT

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Changing the way misoprostol is administered and introducing oral antibiotics into the pill regimen for medical abortion greatly decreased the risk of a rare infection, according to a study published Thursday in the New England Journal of Medicine, the New York Times reports (Grady, New York Times, 7/9). Medical abortion, which can be used during the first nine weeks of gestation, involves administration of the drug mifepristone followed within two days by misoprostol (Johnson, AP/Long Island Newsday, 7/9). Medical abortions account for nearly 25% of all early abortion procedures in the U.S., according to the San Francisco Chronicle (Allday, San Francisco Chronicle, 7/9).

When FDA approved the medical abortion regimen in 2000, it required that the drugs be taken orally. However, later research indicated that misoprostol was more effective when taken in smaller doses vaginally, and many providers switched to that method. Providers also found that buccal administration -- having women place the pill between their cheek and gums and letting it dissolve -- also was more effective than taking the pill orally (New York Times, 7/9). Between 2000 and 2006, seven women died from serious infections after taking the pill vaginally, while in Europe -- where medical abortions are much more popular and misoprostol is swallowed -- there were almost no cases of serious infection (San Francisco Chronicle, 7/9).

Researchers suspected that vaginal administration was tied to the infection, the Times reports (New York Times, 7/9). In March 2006, Planned Parenthood changed the way it administered misoprostol at its clinics to the buccal route. In July 2007, the organization required that all women undergoing medical abortions also be given antibiotics.

The new study examined nearly 250,000 medical abortions performed at Planned Parenthood clinics between January 2005 and June 2008. It found that before the drug delivery change, there were 69 cases of serious infection, which the study defined as infections requiring treatment with intravenous antibiotics. Following the drug delivery change and the later addition of antibiotics to the regimen, only five serious infections occurred (San Francisco Chronicle, 7/9). According to the study, the infection rate dropped from 0.93 per 1,000 abortions to 0.06 per 1,000 abortions.

Implications for Medical Practice Unclear

It is unclear what effect the findings will have on medical practice, according to the Times. Lead author Mary Fjerstad, a nurse practitioner, said, "Our data show there was a reduction in serious infections when we switched to a nonvaginal route of misoprostol administration. But I don't want to come down on the side of saying that everybody everywhere should give antibiotics with every medical abortion. Providers should decide that." Vicki Saporta, president of the National Abortion Federation, said the group's medical experts would review the findings. About one-third of NAF members give misoprostol vaginally, she estimated. The group's current guidelines allow oral, buccal and vaginal administration but do not include routine use of antibiotics, the Times reports.

Abby Long, a spokesperson for Danco Laboratories -- which sells Mifeprex, the brand name of misoprostol -- said the company is not planning to change the drug's labeling and has not discussed the study's findings with FDA. An FDA spokesperson said the agency is "carefully reviewing" the findings (New York Times, 7/9).

Paul Blumenthal, a professor of obstetrics and gynecology at the Stanford University School of Medicine, said it is not clear why vaginal administration seems to have a higher risk of infection. He added, "Just changing the route of misoprostol, which costs nothing, had a great effect. And it's certainly no less convenient for women" (San Francisco Chronicle, 7/9). Blumenthal said that he would recommend the buccal route but that requiring antibiotics, which might be unaffordable or unavailable in developing countries, could prevent women from obtaining medical abortion in those areas (New York Times, 7/9).

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