Levofloxacin plus metronidazole in uncomplicated pelvic inflammatory disease: a preliminary study

Area of Science:

• Infectious Diseases
• Gynecology
• Pharmacology

Background:

• Uncomplicated pelvic inflammatory disease (PID) is a common condition with diverse causative pathogens, including sexually transmitted infections and vaginal flora.
• Current oral treatment protocols often involve ofloxacin plus metronidazole (MET).
• Levofloxacin (LEV) has been suggested as an alternative to ofloxacin in treatment guidelines.

Purpose of the Study:

• To evaluate the efficacy and safety of a combined oral regimen of levofloxacin (LEV) and metronidazole (MET) for treating uncomplicated PID.
• To assess clinical resolution and bacteriological eradication rates.
• To document drug-related adverse events associated with the LEV-MET treatment.

Main Methods:

• A prospective study evaluated 40 patients diagnosed with uncomplicated PID.
• Treatment consisted of oral levofloxacin 500mg once daily plus metronidazole 500mg twice daily for 14 days.
• Clinical and microbiological endpoints were assessed at the end of therapy (EOT) and at a 4-6 week follow-up (FU).

Main Results:

• Pathogen identification revealed common culprits including E. coli, anaerobes, Chlamydia trachomatis, Mycoplasma hominis, and Ureaplasma urealyticum.
• At EOT, 37 patients were evaluable, with 27 achieving clinical cure and 10 showing significant improvement. All identified pathogens were eradicated.
• At FU, all 35 evaluable patients achieved clinical cure. Adverse events occurred in 9 cases, with one discontinuation due to myalgia and tendonitis.

Conclusions:

• A 14-day oral course of levofloxacin plus metronidazole (LEV-MET) is effective for treating uncomplicated PID in an outpatient setting.
• The LEV-MET regimen demonstrated high rates of clinical cure and pathogen eradication.
• The treatment was generally well-tolerated, with a low incidence of significant adverse events.