Comparative evaluation of clindamycin/gentamicin and cefoxitin/doxycycline for treatment of pelvic inflammatory disease: a multi-center trial. The European Study Group.

Abstract

The clinical efficacy and safety of clindamycin-gentamicin versus doxycycline-cefoxitin in the treatment of acute pelvic inflammatory disease was evaluated in a comparative, randomized, prospective, multicenter study. Ten investigators enrolled 170 patients. Those judged to be eligible for efficacy were 60/88 (68%) who received the clindamycin-gentamicin regimen and 55/82 (67%) of those treated with cefoxitin-doxycycline. A successful clinical outcome was attained for 52/60 (87%) and 46/55 (84%) for patients treated with clindamycin-gentamicin and cefoxitin-doxycycline, respectively, a difference that was not statistically significant. In the clindamycin-gentamicin series, 8/8 (100%) of patients with positive C. trachomatis culture at baseline were culture negative at the late follow-up 21-35 days after treatment. For those given cefoxitin-doxycycline, 9/11 (82%) who had C. trachomatis at pretreatment showed eradication at follow-up. Neisseria gonorrhoeae was present at baseline in 8/60 (13%) of the clindamycin-gentamicin patients and in 9/55 (16%) of those treated with cefoxitin-doxycycline. Of those who had appropriate follow-up cultures performed, 6 in the clindamycin-gentamicin group and 8 in the cefoxitin-doxycycline series, all showed eradication of the organism. It is concluded that clindamycin-gentamicin and cefoxitin-doxycycline have similar clinical cure rates for acute pelvic inflammatory disease, and based on this limited experience, it is suggested that the clindamycin-gentamicin combination will satisfactorily eradicate Chlamydia trachomatis and Neisseria gonorrhoeae when either or both of these pathogens are present.