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Pelvic inflammatory disease: metaanalysis of antimicrobial regimen efficacy
C K Walker1, J G Kahn, A E Washington
1Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco.
Abstract:
An extensive body of literature has investigated the efficacy of antimicrobial regimens used to treat pelvic inflammatory disease (PID), leaving many clinicians confused about how to choose among them. This study provides a formal appraisal of these reports. Thirty-four treatment studies published between 1966 and 1992 were identified, using Medline and bibliographies, and evaluated qualitatively and quantitatively in a metaanalysis. Twenty-one studies met the criteria for inclusion in this evaluation: appropriate system for making the diagnosis of PID, standardized assessment of clinical outcome, and entry and follow-up evaluation for lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis. This metaanalysis identifies a considerable range of quality in study methods and research design and underscores the limitations inherent in comparing such data. Despite this, a number of antimicrobial regimens appear to have very good short-term clinical and microbiologic efficacy. Pooled clinical cure rates range from 75% to 94% and pooled microbiologic cure rates range from 71% to 100%. A cost comparison is provided, and future research priorities are suggested.
Insights
Clinicians can choose from several effective antimicrobial regimens for pelvic inflammatory disease (PID). This meta-analysis of 21 studies confirms high short-term clinical and microbiologic cure rates for PID treatment.
Area of Science:
- Infectious Diseases
- Gynecology
- Pharmacology
Background:
- Extensive literature exists on antimicrobial regimens for pelvic inflammatory disease (PID).
- Clinician confusion persists regarding optimal treatment selection.
- A formal appraisal of existing treatment studies is needed.
Purpose of the Study:
- To formally appraise and evaluate the efficacy of antimicrobial regimens for pelvic inflammatory disease (PID).
- To provide a qualitative and quantitative meta-analysis of relevant treatment studies.
- To guide clinicians in selecting effective PID treatment strategies.
Main Methods:
- A systematic literature search identified 34 treatment studies published between 1966 and 1992.
- Twenty-one studies met inclusion criteria, including diagnostic accuracy, outcome assessment, and pathogen evaluation (Neisseria gonorrhoeae, Chlamydia trachomatis).
- Qualitative and quantitative meta-analysis was performed on the selected studies.
Main Results:
- Significant variability in study quality and research design was observed.
- Several antimicrobial regimens demonstrated high short-term clinical efficacy, with pooled cure rates from 75% to 94%.
- Pooled microbiologic cure rates ranged from 71% to 100%.
Conclusions:
- Despite methodological limitations in the literature, effective antimicrobial regimens for short-term PID treatment are identifiable.
- The meta-analysis provides evidence supporting the efficacy of various treatment options.
- Future research priorities and cost comparisons are discussed.