Materials and Methods: A Markov model of antibiotic side effects, infection and infection sequelae (ectopic, chronic pain and infertility) was developed. Three options were considered: no antibiotics, prophylactic antibiotics (pre-abortion single-dose) and treatment-dose antibiotics (postabortion multiple-dose). Two models were run using either a 20-year-old or a 30-year-old woman who desires children in the future. One-way, two-way and Monte Carlo sensitivity analyses were performed. A $50 000 per quality-adjusted life year threshold was used for cost-effectiveness. Results: For a 20-or 30-year-old woman, no antibiotic is favored if the baseline infection risk is b 0.6% or b 0.8%, respectively. Treatment-dose antibiotics is favored if the risk of infection exceeds 3.7% or 4.8%, respectively. Otherwise, prophylactic antibiotics are favored. Discussion: Results were sensitive to varying relative infection risk between prophylactic and treatment regimens but were robust to variation of other cost and outcome parameters. Conclusion: Further study is needed to examine antibiotic use in settings with a low incidence of postabortal infection and to compare prophylactic and treatment regimens directly. Further delineation of the sequelae of postabortal infection is also needed.
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