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Abortion drug's off-label use may have led to deaths
Date:6/16/2008

ly when it issued a warning in 2006 that advised doctors against off-label vaginal use of misoprostol in medication abortions. But many clinicians and patients have opted to use misoprostol vaginally instead, in part to avoid side effects women often have when receiving the drug by mouth.

Out of the hundreds of thousands of women who have taken the two-drug combination safely, there have been eight reported deaths after infections of Clostridium bacteria. The drug was given vaginally in all but one of these cases. Six out the eight women were infected with Clostridium sordellii, a type which rarely causes illness in people. The other two contracted a related Clostridium bacterium.

Clostridium sordellii is being closely watched by the federal Centers for Disease Control and Prevention and others because of the abortion-related deaths and because it is biologically very similar to another form of Clostridium bacteria, Clostridium difficile. C. difficile is of great concern especially in hospitals and other clinical settings, where it is causing increasing rates of infections.

Study findings: The U-M scientists showed that rats given misoprostol injected in the uterus and then exposed to Clostridium sordellii had high mortality rates: 80 percent died within four days. By contrast, rats given misoprostol through the stomach and exposed to the bacteria showed no increased mortality over infected animals that did not receive the drug.

Cell culture studies also revealed misoprostol weakened several key immune defenses in the reproductive tract. The drug suppressed the action of macrophages, immune cells that normally engulf and kill invading bacteria, and the action of neutrophils. It also inhibited certain other immune defenses, including the production of anti-bacterial chemicals normally made by cells lining the uterus.

Implications: The study results have implications for a much wider segment of women who experience s
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Contact: Anne Rueter
arueter@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert  

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