Sa1231 Awareness Among Practitioners Regarding Efficacy of Oral Contraceptives With Concomitant use of Antibiotics in Inflammatory Bowel Disease (IBD) Patients

Abstract

Background: Antibiotics such as metronidazole and ciprofloxacin are often prescribed to IBD patients. Common misperception is that use of antibiotics can decrease efficacy of oral contraceptives (OCPs) and result in contraception failure, refuted in a recently published guideline from the American College of Obstetrics and Gynecology. The purpose of this study was to assess the knowledge among practitioners regarding the lack of evidence to support decreased contraceptive efficacy with concomitant use of OCPs and antibiotics. Methods: We conducted a survey of 215 practitioners (GI-General n=36, IBD specialists n= 11, GI-Fellows n=39, Internal Medicine n=44, Family Medicine n=29, OB/Gyn n=19 and Pharmacists n=37). Practitioners were quizzed on two scenarios in which a 28-year-old female patient with fistulizing Crohn's disease on an OCP was recently prescribed ciprofloxacin or metronidazole. The practitioners were asked whether they would: 1) ask the patient to use an alternativemethod of contraception, 2) ask the patient to use twomethods of contraception, or 3) inform the patient that there is no evidence to support decreased contraceptive efficacy with the concomitant use of OCPs and antibiotics. The percentage of practitioners among the different groups was compared using either χ2 or Fisher's exact test as appropriate. Multiple, pair-wise comparisons were then performed if the overall χ2 test or Fisher's exact test was statistically significant. The p-value was adjusted for multiple comparisons. Results: Compared to all other specialties combined, IBD specialists and OB/Gyns were more likely to accurately believe that there is no evidence to support a lack of contraceptive efficacy with concomitant use of ciprofloxacin (91% vs. 20% p <0.0005 and 90% vs.17% p <0.0005 respectively) and metronidazole (100% vs. 26% and 95% vs. 23% p <0.0005 respectively) (Figure 1). Knowledge among gastroenterologists (except for IBD specialists) for both questions was not statistically any different than internists (18% vs. 4%p=0.245), family physicians (18% vs. 0% p=0.11) or pharmacists (18% vs. 18% p=1.00). Ninety-eight percent of the practitioners who thought there was an interaction between antibiotics and OCPs answered that the information learned from this survey will change their practice. Conclusion: Excluding IBD specialists and OB/Gyns, most practitioners involved in the care of female patients with IBD believe there to be interaction between antibiotics and OCPs and would prescribe an alternative method of contraception or two different methods to such patients. It is thus important to appropriately educate those without the appropriate knowledge in order that patients are not falsely counseled to increase means of birth control.