Antibiotic therapy for pelvic inflammatory disease: an abridged version of a Cochrane systematic review and meta-analysis of randomised controlled trials

Abstract

ObjectiveTo assess the effectiveness and safety of antibiotic regimens used to treat pelvic inflammatory disease (PID).DesignThis is a systematic review and meta-analysis of randomised controlled trials (RCTs). Risk of bias was assessed using the criteria outlined in the Cochrane guidelines. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation.Data sourcesEight electronic databases were searched from date of inception up to July 2016. Database searches were complemented by screening of reference lists of relevant studies, trial registers, conference proceeding abstracts and grey literature.Eligibility criteriaRCTs comparing the use of antibiotics with placebo or other antibiotics for the treatment of PID in women of reproductive age, either as inpatient or outpatient treatment.ResultsWe included 37 RCTs (6348 women). The quality of 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. There was no clear evidence of a difference in the rates of cure for mild-moderate or for severe PID for the comparisons of azithromycin versus doxycycline, quinolone versus cephalosporin, nitroimidazole versus no use of nitroimidazole, clindamycin plus aminoglycoside versus quinolone, or clindamycin plus aminoglycoside versus cephalosporin. No clear evidence of a difference between regimens in antibiotic-related adverse events leading to discontinuation of therapy was observed.ConclusionsWe found no conclusive evidence that one regimen of antibiotics was safer or more effective than any other for the treatment of PID, and there was no clear evidence for the use of nitroimidazoles (metronidazole) compared with the use of other drugs with activity against anaerobes. More evidence is needed to assess treatments for women with PID, particularly comparing regimens with or without the addition of nitroimidazoles and the efficacy of azithromycin compared with doxycycline.

Complicated chronic salpingo-oophoritis in young women. Possibilities of conservative therapy

“…Цей документ був доповнений виданими у 2018 і 2019 рр. клінічними настановами Національного інституту здоров'я й удосконалення медичної допомоги Великої Британії (National Institute of Health and Care Excellence, NICE) та Національного коледжу акушерства та гінекології Франції [17]. Однак тема лікування та реабілітації репродуктивної системи пацієнток із ускладненим перебігом ЗЗОМТ і утворенням гідросальпінксу досі лишається контраверсійною.…”

“…При виявленні ділянки обструкції та за бажанням пацієнтки слід застосувати реконструктивні оперативні методики. За відсутності ефекту від консервативного лікування гідросальпінксу, враховуючи сучасний світовий досвід [17], можна рекомендувати лапароскопічну оклюзію маткової труби в проксимальному відділі або сальпінгектомію в залежності від клінічних обставин. ВИСНОВКИ 1.…”

Working together to improve the evidence base: abridged Cochrane reviews in Sexually Transmitted Infections

“…The systematic review by Savaris and colleagues1 is important for two reasons. First is the review of the treatment of pelvic inflammatory disease (PID), a common condition for which the management is contentious, driven by traditions and not necessarily evidence-based.…”

“…The systematic review of antibiotic therapy for PID, which included 37 randomised controlled trials, makes for interesting reading, particularly about the use of nitroimidazoles 1. The evidence suggests that the addition of metronidazole to any of the evaluated regimens does not improve clinical cure for either mild to moderate PID (5 trials, 1383 women) or severe PID (11 trials, 2427 women) 1.…”

“…The evidence suggests that the addition of metronidazole to any of the evaluated regimens does not improve clinical cure for either mild to moderate PID (5 trials, 1383 women) or severe PID (11 trials, 2427 women) 1. The authors judged the quality of the evidence as moderate rather than high, presumably because of missing information from the trial reports (figures 1 and 2 in the published paper) 1. The authors suggest that other antibiotics in the regimens tested must have provided enough anaerobic cover.…”