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Infectious Diseases in Obstetrics and Gynecology
Volume 10, Issue 3, Pages 133-140

Does Pre- and Postoperative Metronidazole Treatment Lower Vaginal Cuff Infection Rate After Abdominal Hysterectomy Among Women With Bacterial Vaginosis?

1Department of Obstetrics and Gynecology, Central Hospital, (Kärnsjukhuset), Skövde S-541 85, Sweden
2Department of Obstetrics and Gynecology, Linköpings Universitet and Division of Clinical Microbiology, Linköpings Universitet, Linköping, Sweden

Received 16 October 2001; Accepted 22 February 2002

Copyright © 2002 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective: Bacterial vaginosis (BV) is a known risk factor for postoperative infection following abdominal hysterectomy. Vaginal bacterial flora scored as intermediate has been shown to have the same risk of postoperative infection as BV.

Methods: Women undergoing total abdominal hysterectomy for benign diseases were open-randomized according to Zelen to either treatmentwith metronidazole rectally for at least 4 days or no treatment. At the preoperative gynecological examination a vaginal smear was collected and Gram stained. Women with BV or intermediate flora were merged to one group called abnormal vaginal flora.

Results: In total 213 women were randomized to treatment or no treatment. After exclusion of 71 women, 142 women were eligible for analysis. Among the 59 women diagnosed with abnormal vaginal flora there were no vaginal cuff infections in the treated arm, comparedwith 27% in the ‘no treatment’ arm (p <0.01). Treatment also reduced the vaginal cuff infection rate from 9.5 to 2% among the 83 women with lactobacilli flora. However, this difference was not statistically significant. Treatment had no effect on the rate of wound infections. Intention-to-treat analysis showed a significant reduction in vaginal cuff infections among women randomized to treatment.

Conclusion: Pre- and postoperative treatment for at least 4 days with metronidazole rectally reduces significantly vaginal cuff infection among women with abnormal vaginal flora.