According to a new report just two changes in the way Planned Parenthood clinics perform medical abortion resulted in a 93% drop in the rate of serious infections.

The changes were simple and involved the pills being taken by mouth instead of vaginally, and with routine treatment with antibiotics.

Mary Fjerstad, a nurse practitioner who was director of clinical quality improvement at the Planned Parenthood Federation of America when the study was conducted and lead author of a paper appearing in the July 9 issue of the New England Journal of Medicine said, "Planned Parenthood is very happy with the regimen. We've got the same head-to-head efficacy as with vaginal delivery and a significant reduction in infections. And, since we added antibiotics, we have a further drop in serious infections."

Medical abortion, which is an abortion induced by medication rather than surgery is provided by 300 Planned Parenthood clinics, the nation’s largest abortion provider in the United States.

Medical abortion is done in three ways; only misoprostol; methotrexate followed by misoprostol; and mifepristone or the "abortion pill" followed by misoprostol.

The most commonly used method is the combination of mifepristone and misoprostol which was approved by the Food and Drug Administration and required that both drugs be swallowed. Later studies found that giving the second drug vaginally worked better, with smaller doses, and many providers switched to that method, where they gave mifepristone orally followed 24 to 48 hours later with misoprostol administered vaginally.

Although earlier research had shown this method to have a 98 % success rate in inducing abortions, in 2005 five North American women were reported to have died from Clostridium sordellii, an otherwise rare bacterial infection within a week of taking mifepristone.

The new study conducted and paid for by Planned Parenthood, analyzed the records of 227,823 women who had abortions at its clinics from January 2005 to June 2008. They compared the risk in women to whom misoprostol was given vaginally to those who received buccal administration in which the misoprostol pill is tucked between the gums and the cheek and allowed to dissolve in concert with antibiotics. They found 92 had serious infections and the rate of serious infections dropped 73 % from 0.93 per 1,000 abortions before introduction of buccal administration along with antibiotics or STD screening to 0.25 per 1,000 abortions after the change. The addition of antibiotics dropped the rate of serious infections a further 76%.

Fjerstad said, “Our data show there was a reduction in serious infections when we switched to a nonvaginal route of misoprostol administration. But I don’t want to come down on the side of saying that everybody everywhere should give antibiotics with every medical abortion. Providers should decide that.”

Dr. Karen Loeb Lifford, director of family planning at Boston University School of Medicine said, “I do think the antibiotics will become the standard of care in the United States,” adding she had already changed her clinic’s practice to use the buccal route and include antibiotics.

Abby Long, a spokeswoman for Danco Laboratories, which sells Mifeprex, said they were not planning any changes in the drug’s labeling or directions. Any proposed changes in the label would first have to be approved by the F.D.A.

The results are to be published on Thursday in The New England Journal of Medicine.