Empirical Antibiotic Therapy in Chronic Endometritis With and Without Focal Lesions: A Prospective Cohort Study

Objective: This study aimed to evaluate the efficacy of empirical antibiotic therapy in treating chronic endometritis (CE) associated with abnormal uterine bleeding (AUB), infertility, or intrauterine lesions. Methods: The prospective cohort study involved 102 women undergoing outpatient hysteroscopy (OH), with immunohistochemical diagnosis of CE based on plasma cell density (PCD). Seventy-six of these women received empirical antibiotic therapy (ofloxacin and metronidazole), while 26 did not. A follow-up OH was conducted in the third cycle following the initial procedure. Results: Hysteroscopic polypectomy significantly reduced PCD regardless of antibiotic use (p = 0.009). In cases without focal lesions but exhibiting CE features, antibiotic therapy notably decreased PCD (p = 0.018). The incidence of certain histopathological features of CE, such as stromal edema and stromal cell compaction, was significantly lower in women treated with antibiotics (p = 0.014). Among intrauterine pathologies, endometrial polyps (p = 0.009) and cesarean scar defects (p = 0.011) significantly increased the risk of CE. Only spindled transformation of stromal cells with edema correlated significantly with elevated PCD (p = 0.022). Antibiotic therapy did not improve obstetric outcomes. Conclusions: Polypectomy alone reduced PCD without antibiotics, while antibiotic treatment significantly decreased PCD and resolved CE features in cases without focal lesions. Therefore, antibiotics may be prioritized for cases without focal lesions, whereas surgical intervention may be sufficient for CE associated with eligible pathologies.