Exploring Antibiotic-Mediated Disruption of Enterohepatic Circulation and Combined Oral Contraceptive Efficacy: A Systematic Review.

Background: Combined oral contraceptives (COCs) are essential for the well-being and reproductive health of millions of women globally. Despite their widespread use, concerns among clinicians persist about potential drug-drug interactions between antibiotics and COCs. This systematic review evaluates existing literature on the interaction between antibiotics and COC efficacy, offering guidance for clinicians in managing the use of contraception alongside antibiotics.

Materials and methods: Utilizing Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, a comprehensive literature search was conducted using PubMed, Clinical Trials.gov, Cochrane Library, and Google Scholar, focusing on studies published from 2000 to 2024. The search strategy was centered on peer-reviewed observational and experimental studies.

Results: Initial analysis of the databases resulted in 712 potential articles. Nine articles were chosen relative to specific inclusion and exclusion criteria. While most antibiotics did not compromise COC effectiveness, enzyme-inducing antibiotics, particularly rifampicin, significantly reduced COC efficacy.

Conclusion: Although common antibiotics pose minimal risk to COC effectiveness, clinicians should remain vigilant when prescribing enzyme-inducing antibiotics such as rifampicin. When these antibiotics are used, it is advisable to consider additional or alternative contraceptive methods to ensure continued pregnancy prevention.