DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20191583

A comparative study of moxifloxacin versus combination of doxycycline and metronidazole for treatment of uncomplicated pelvic inflammatory disease

Priyadharshini M., Sarmila Nath, Gourisankar Kamilya, Raja Roy

Abstract


Background: Pelvic inflammatory disease (PID), a common condition among women of reproductive age caused by various aerobic and anaerobic organisms, may sometimes lead to complications like infertility, ectopic pregnancy and chronic pelvic pain. Moxifloxacin is a broad spectrum bactericidal antibiotic acting against many gram positive, gram negative aerobic organisms and anaerobes. Rapid absorption and high bioavailability allow single daily dosing and improves compliance. The present study was done to compare the clinical and microbiological outcomes in  PID patients treated with conventional doxycycline- metronidazole  and moxifloxacin therapy.

Methods: Women with uncomplicated PID, randomized into two groups either received 400 mg single dose of moxifloxacin daily for 14 days (group A) or doxycycline 100 mg + metronidazole 500 mg twice daily for 14 days (group B). Temperature, TLC count, ESR, CRP, microbiological assessment, Visual analogue score for pain, vaginal discharge, dyspareunia and backache were noted. The bacteriological cure was assessed by high vaginal swab for organism identification by gram stain, 10% KOH and blood sample by ELISA.

Results: Total 60 women were enrolled and randomized into two groups. There was significant reduction of CRP and improved TLC in the moxifloxacin treated group. Visual analogue scores for pain, vaginal discharge and malaise were significantly reduced in the group treated with moxifloxacin.  Nausea, vomiting, metallic taste, dyspepsia and diarrhoea were complained by a significant number of patients of doxycycline + metronidazole group, in contrast to the patients receiving moxifloxacin.

Conclusions: Moxifloxacin 400 mg once daily, is effective and safe for treatment of PID.


Keywords


Doxycycline, Metronidazole, Moxifloxacin, Pelvic inflammatory disease

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References


Ness RB, Hillier SL, Richter HE, et al. Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina. Obstet Gynecol. 2002;100:765-72.

Hillier SL, Kiviat NB, Hawes SE, Hasselquist MB, Hanssen PW, Eschenbach DA, et al. Role of bacterial vaginosis–associated microorganisms in endometritis. Am J Obstetr Gynecol. 1996;175(2):435-41.

Haggerty CL, Hillier SL, Bass DC, Ness RB. Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis. 2004;39:990-5.

Haggerty CL, Totten PA, Astete SG, Ness RB. Mycoplasma genitalium among women with nongonococcal, nonchlamydial pelvic inflammatory disease. Infect Dis Obstet Gynecol. 2006;2006.

Simms I, Eastick K, Mallinson H, Thomas K, Gokhale R, Hay P, Herring A, Rogers PA. Associations between Mycoplasma genitalium, Chlamydia trachomatis and pelvic inflammatory disease. J Clin Pathol. 2003;56(8):616-8.

Cohen CR, Manhart LE, Bukusi EA, Astete S, Brunham RC, Holmes KK, et al. Association between Mycoplasma genitalium and acute endometritis. Lancet. 2002;359(9308):765-6.

Westrom L, Joesoef R, Reynolds G, Hagdu A, Thompson SE. Pelvic inflammatory disease and fertility. Sex Transm Dis. 1992;19:185-92.

Pelvic Inflammatory Disease. Available at: https://emedicine.medscape.com/article/256448-overview#a6. Accessed 27 October 2018.

Wiesenfeld HC, Sweet RL, Ness RB, Krohn MA, Amortegui AJ, Hillier SL. Comparison of acute and subclinical pelvic inflammatory disease. Sexually Transm Dis. 2005 Jul 1;32(7):400-5.

Bevan CD, Ridgway GL, Rothermel CD. Efficacy and safety of azithromycin as monotherapy or combined with metronidazole compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease. J Int Med Res. 2003;31:45-54.

Savaris RF, Teixeira LM, Torres TG, Edelweiss MI, Moncada J, Schachter J. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Obstet Gynecol. 2007;110(1):53-60.

Heystek M, Ross JD. A randomized double-blind comparison of moxifloxacin and doxycycline/metronidazole/ciprofloxacin in the treatment of acute, uncomplicated pelvic inflammatory disease. Int J STD AIDS. 2009;20:690-5.

Boothby M, Page J, Pryor R, Ross JD. A comparison of treatment outcomes for moxifloxacin versus ofloxacin/metronidazole for first-line treatment of uncomplicated non-gonococcal pelvic inflammatory disease. Int J STD AIDS. 2010;21(3):195-7.

Judlin P, Liao Q, Liu Z, Reimnitz P, Hampel B, Arvis P. Efficacy and safety of moxifloxacin in uncomplicated pelvic inflammatory disease: the MONALISA study. BJOG: Int J Obstet Gynaecol. 2010;117(12):1475-84.

Sexually Transmitted Diseases Treatment Guidelines: 2015. Available at: https://www.cdc.gov/std/tg2015/pid.htm. Accessed 2 September 2017.

Bébéar CM, De Barbeyrac B, Pereyre S, Renaudin H, Clerc M, Bébéar C. Activity of moxifloxacin against the urogenital mycoplasmas Ureaplasma spp., Mycoplasma hominis and Mycoplasma genitalium and Chlamydia trachomatis. Clin Microbiol Infect. 2008 Aug;14(8):801-5.

Lode HM, Schmidt-Ioanas M. Moxifloxacin: update and perspectives after 8 years of usage. Expert Rev Resp Med. 2008;2(4):443-53.

Boswell FJ, Andrews JM, Jevons G, Wise R. Comparison of the in vitro activities of several new fluoroquinolones against respiratory pathogens and their abilities to select fluoroquinolone resistance. J Antimicrob Chemotherapy. 2002;50(4):495-502.

Asicioglu O, Gungorduk K, Ozdemir A, Ertas IE, Yildirim G, Sanci M, Ark C. Single daily dose of moxifloxacin versus ofloxacin plus metronidazole as a new treatment approach to uncomplicated pelvic inflammatory disease: a multicentre prospective randomized trial. Eur J Obstet Gynecol Reprod Biol. 2013;171(1):116-21.

Centers for Disease Control and Prevention. Pelvic inflammatory disease: Guidelines for prevention and management. MMWR Recomm Rep. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/00031002.htm.

Ross J, Judlin P, Nilas L. European guideline for the management of pelvic inflammatory disease. In J STD AIDS. 2007;18(10):662-6.

Ross JD, Cronje HS, Paszkowski T, Rakoczi I, Vildaite D, Kureishi A, et al. Moxifloxacin versus ofloxacin plus metronidazole in uncomplicated pelvic inflammatory disease: results of a multicentre, double blind, randomised trial. Sexually Transm Infect. 2006;82(6):446-51.

Haggerty CL, Ness RB. Newest approaches to treatment of pelvic inflammatory disease: a review of recent randomized clinical trials. Clin Infect Dis. 2007;44(7):953-60.

Dunbar-Jacob J, Sereika SM, Foley SM, Bass DC, Ness RB. Adherence to oral therapies in pelvic inflammatory disease. J Women's Health. 2004;13(3):285-91.

Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health

(PEACH) Randomized Trial. Am J Obstet Gynecol. 2002;186(5):929-37.

Ball P, Stahlmann R, Kubin R, Choudhri S, Owens R. Safety profile of oral and intravenous moxifloxacin: cumulative data from clinical trials and postmarketing studies. Clin Therapeu. 2004;26(7):940-50.