Antibiotic therapy for pelvic inflammatory disease.

Area of Science:

• Infectious Diseases
• Pharmacology
• Gynecology

Background:

• Pelvic inflammatory disease (PID) is a common cause of morbidity in young women, affecting 4% to 12% of this demographic.
• Current primary treatment involves broad-spectrum antibiotics targeting Chlamydia trachomatis, Neisseria gonorrhoeae, and anaerobic bacteria.

Purpose of the Study:

• To evaluate the effectiveness and safety of various antibiotic regimens for treating pelvic inflammatory disease (PID).
• To compare different antibiotic treatments based on current clinical guidelines.

Main Methods:

• Conducted a systematic review of randomized controlled trials (RCTs) published up to July 2016.
• Searched multiple databases including Cochrane, MEDLINE, Embase, and others for relevant studies.
• Included RCTs comparing antibiotics to placebo or other antibiotics for PID treatment in women of reproductive age.

Main Results:

• Included 37 RCTs involving 6348 women; evidence quality ranged from very low to high, with limitations in bias, inconsistency, and imprecision.
• No clear evidence showed significant differences in cure rates or adverse effects between azithromycin and doxycycline, quinolones and cephalosporins, or nitroimidazoles and other anaerobic agents.
• A sensitivity analysis indicated azithromycin might be superior to doxycycline for mild-moderate PID (moderate-quality evidence from one low-risk-of-bias study).

Conclusions:

• No definitive evidence supports one antibiotic regimen over another for PID cure or safety.
• Moderate evidence suggests azithromycin may be more effective than doxycycline for mild-to-moderate PID.
• The review focused on antibiotics recommended by the 2015 US CDC guidelines.