Authors' objectives:

This systematic review investigated the clinical effectiveness and cost-effectiveness of antibiotic treatments for pelvic inflammatory disease, particularly in relation to the seven currently recommended treatment regimens.

Authors' results and conclusions: For the assessment of clinical effectiveness 34 randomised controlled trials met the inclusion criteria. Many were small and the reporting quality was generally poor. Most of them had short follow ups of less than two weeks. A very wide variety of antibiotic regimens were compared. All trials except two reported clinical cure rates. Meta-analysis was carried out where two or more trials used the same antibiotics or combinations. For several of the standard antibiotic regimens, there was no randomised controlled trial evidence available. For standard treatment regimens with evidence, no significant differences of any of the comparisons were found. Only one non-standard regimen had a significantly worse outcome than the comparator and that was clindamycin used on its own. One large trial compared inpatient and outpatient treatment, using very similar antibiotic combinations. There were no significant differences between the two groups at a mean follow up of 35 months.

Authors' recommendations: There is no clear evidence to demonstrate the greater efficacy of any of the clinically meaningful interventions reviewed compared to any of the others. It would seem sensible, therefore that, other things being equal, the least expensive drug regimens be used in the first instance. There is a need for large, good quality RCTs, adequately powered to detect small effect sizes, to establish whether any of the recommended antibiotic regimens are relatively more effective than any of the others. There is also a need to improve the diagnosis and management of PID in primary care.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/WMHTAC/REPreports/2004/Pelvic_Inflammatory_Disease.pdf

Year Published: 2004

URL for published report: http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PHEB/WMHTAC/REP/reports-list.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: West Midlands Health Technology Assessment Collaboration

Contact Address: Elaena Donald-Lopez, West Midlands Health Technology Assessment Collaboration, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT Tel: +44 121 414 7450; Fax: +44 121 414 7878

Contact Name: louise.a.taylor@bham.ac.uk

Contact Email: louise.a.taylor@bham.ac.uk

Copyright: University of Birmingham