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Risk-based versus alternative algorithms for antibiotic
prophylaxis among women seeking early suction abortion: a cost-effectiveness
simulation.
Sexually Transmitted Diseases 2001;28(12):714-724.
Friedman HB, Gift TL, Susanti I, Wasserheit JN.
Abstract
BACKGROUND: Particularly in resource-poor settings, simple, inexpensive,
and cost-effective algorithms are needed to direct antibiotic prophylaxis
to prevent sequelae of infections with Chlamydia trachomatis, Neisseria
gonorrhoeae, and bacterial vaginosis-associated organisms among women
undergoing abortion. GOAL: To assess the prevalence of and risk factors
for infections among women seeking abortion in Bali, Indonesia, and to
use these data in designing a cost-effective risk-based prophylaxis algorithm.
STUDY DESIGN: A cross-sectional analysis and data-based simulation of
risk-based and alternative prophylaxis algorithms were performed. RESULTS:
The risk-based algorithm would have provided prophylaxis to 70% (95%
CI, 53-83%) of women with cervical infection, 64% (95% CI, 54-74%) of
those with bacterial vaginosis, and 57% (95% CI, 42-72%) of those with
trichomoniasis. For cervical infection, the algorithm was more cost effective
than all others evaluated. The cost-effectiveness was acceptable for
bacterial vaginosis. CONCLUSIONS: Risk-based algorithms may be cost effective
in identifying women likely to benefit from preabortion prophylaxis.
Prospective evaluation is needed to validate these findings.