Infection following miscarriage surgery is a problem affecting over 33 million pregnancies each year. A majority of women will have their miscarriage managed with surgery to empty the womb.  Infection can occur following this surgery and this is a particular problem in low income countries. In some low income countries the rates of infection following miscarriage surgery are as high as 30%.  These infections can result in death, serious illness or long-term health problems.


Currently international and national medical guidelines do not recommend antibiotics to be given routinely in miscarriage surgery, because there is no evidence that tells us that this is effective. We propose that if antibiotics are given just before the procedure of miscarriage surgery this may reduce the chance of infection occurring. We will test this in the form of a large clinical trial conducted in four low income countries.


Women having miscarriage surgery who are not showing any signs of infection will be invited to participate. If consent is given women will be offered either a single dose of prophylactic antibiotics (400mg doxycycline and 400mg metronidazole) or an identical looking dummy pill (placebo), to be taken by mouth before the surgery. Both the woman and health worker will not know which type of tablets they have been given. The use of dummy pills helps identify the true difference the antibiotics make. We will carefully follow participants for 2 weeks after surgery to see if there is any difference in the rate of women developing pelvic infection. If any women show signs of infection they will be given full treatment as soon as it is detected. We will also see if using antibiotics before surgery is cost effective.