Antibiotic therapy for pelvic inflammatory disease

Area of Science:

• Gynecology and Obstetrics
• Infectious Diseases
• Pharmacology

Background:

• Pelvic inflammatory disease (PID) affects 4%-12% of women of reproductive age.
• Acute PID is primarily treated with broad-spectrum antibiotics.
• Optimal antibiotic regimens for PID require assessment.

Purpose of the Study:

• To assess the effectiveness and safety of various antibiotic regimens for treating PID.
• To compare different antibiotic treatments based on current clinical guidelines.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) up to January 2020.
• Included RCTs compared antibiotics with placebo or other antibiotics for PID.
• Focused on drugs recommended by the 2015 US CDC guidelines.

Main Results:

• 39 RCTs (6894 women) were included; evidence quality ranged from very low to high.
• Uncertainty exists regarding differences between azithromycin and doxycycline for mild-moderate PID cure.
• Sensitivity analysis suggests azithromycin may improve cure rates for mild-moderate PID compared to doxycycline.
• Limited or no significant differences were found between quinolones and cephalosporins, or with/without nitroimidazoles.
• Evidence on clindamycin plus aminoglycoside versus quinolones or cephalosporins showed uncertainty in effectiveness and safety.

Conclusions:

• Overall uncertainty remains regarding the safest and most effective PID treatment.
• Azithromycin might offer a probable improvement in cure rates for mild-moderate PID over doxycycline, based on limited high-quality evidence.
• Further research is needed to clarify optimal antibiotic strategies for PID.