Antibiotic therapy for pelvic inflammatory disease

• Published in: Cochrane database of systematic reviews 2020-08, Vol.8 (8), p.CD010285
• Main Authors: Savaris, Ricardo F, Fuhrich, Daniele G, Maissiat, Jackson, Duarte, Rui V, Ross, Jonathan
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aminoglycosides - adverse effects; Aminoglycosides - therapeutic use; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Azithromycin - adverse effects; Azithromycin - therapeutic use; Cephalosporins - adverse effects; Cephalosporins - therapeutic use; Child health; Clindamycin - adverse effects; Clindamycin - therapeutic use; Doxycycline - adverse effects; Doxycycline - therapeutic use; Drug Therapy, Combination; Female; Gynaecology; Humans; Infectious disease; Nitroimidazoles - adverse effects; Nitroimidazoles - therapeutic use; Pelvic Inflammatory Disease - drug therapy; Pelvic Inflammatory Disease - microbiology; Publication Bias; Quinolones - adverse effects; Quinolones - therapeutic use; Randomized Controlled Trials as Topic; Reproductive & sexual health; Treatment
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD010285.pub3

Pelvic inflammatory disease (PID) affects 4% to 12% of women of reproductive age. The main intervention for acute PID is broad-spectrum antibiotics administered intravenously, intramuscularly or orally. We assessed the optimal treatment regimen for PID.  OBJECTIVES: To assess the effectiveness and safety of antibiotic regimens to treat PID. In January 2020, we searched the Cochrane Sexually Transmitted Infections Review Group's Specialized Register, which included randomized controlled trials (RCTs) from 1944 to 2020, located through hand and electronic searching; CENTRAL; MEDLINE; Embase; four other databases; and abstracts in selected publications. We included RCTs comparing antibiotics with placebo or other antibiotics for the treatment of PID in women of reproductive age, either as inpatient or outpatient treatment. We limited our review to a comparison of drugs in current use that are recommended by the 2015 US Centers for Disease Control and Prevention guidelines for treatment of PID. We used standard methodological procedures expected by Cochrane. Two authors independently extracted data, assessed risk of bias and conducted GRADE assessments of the quality of evidence. We included 39 RCTs (6894 women) in this review, adding two new RCTs at this update. The quality of the evidence ranged from very low to high, the main limitations being serious risk of bias (due to poor reporting of study methods and lack of blinding), serious inconsistency, and serious imprecision. None of the studies reported quinolones and cephalosporins, or the outcomes laparoscopic evidence of resolution of PID based on physician opinion or fertility outcomes. Length of stay results were insufficiently reported for analysis. Regimens containing azithromycin versus regimens containing doxycycline We are uncertain whether there was a clinically relevant difference between azithromycin and doxycycline in rates of cure for mild-moderate PID (RR 1.18, 95% CI 0.89 to 1.55; 2 RCTs, 243 women; I = 72%; very low-quality evidence). The analyses may result in little or no difference between azithromycin and doxycycline in rates of severe PID (RR 1.00, 95% CI 0.96 to 1.05; 1 RCT, 309 women; low-quality evidence), or adverse effects leading to discontinuation of treatment (RR 0.71, 95% CI 0.38 to 1.34; 3 RCTs, 552 women; I = 0%; low-quality evidence). In a sensitivity analysis limited to a single study at low risk of bias, azithromycin probably improves the rates of cure in mild-moderate PID