RESUMO
The aim of this study was to describe a case of a patient with ocular toxoplasmosis, which has resulted in Kyrieleis plaques formation (segmental periarteritis associated with severe inflammation) and later follow-up and alternative treatment due to documented allergy to sulfonamide. A 33-year-old Brazilian woman diagnosed with acute toxoplasmosis, initially treated with sulfonamide, developed a critical cutaneous rash. Cotrimoxazole was changed to clindamycin and pyrimethamine, and prednisone was started. The medication was maintained for 45 days. Four months later, she developed retinal lesions suggestive of toxoplasmosis with Kyrieleis plaques in the upper temporal vessels. Pyrimethamine, clindamycin, and prednisone were initiated until healing. She presented reactivation months later, and a suppressive treatment with pyrimethamine was instituted for one year. This is the first report to use the combination of clindamycin with pyrimethamine in the treatment and recurrence prophylaxis for OT in a documented allergy to sulfonamide.
Assuntos
Clindamicina , Pirimetamina , Sulfonamidas , Toxoplasmose Ocular , Humanos , Feminino , Adulto , Pirimetamina/uso terapêutico , Pirimetamina/efeitos adversos , Toxoplasmose Ocular/tratamento farmacológico , Sulfonamidas/uso terapêutico , Sulfonamidas/efeitos adversos , Clindamicina/uso terapêutico , Recidiva , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Brasil , Antiprotozoários/uso terapêutico , Antiprotozoários/efeitos adversos , Resultado do Tratamento , Prednisona/uso terapêuticoRESUMO
La sialoadenitis crónica esclerosante puede extenderse desde una sialoadenitis focal hasta una cirrosis completa de la glándula. Aparece entre los 40 y 70 años de edad y afecta principalmente a la glándula submandibular. Se asocia con sialolitos y agentes infecciosos inespecíficos. La causa más frecuente de sialolitiasis es la formación de cálculos macroscópicamente visibles en una glándula salival o en su conducto excretor, de los cuales el 80 % al 90 % provienen de la glándula submandibular. Esta predilección probablemente se deba a que su conducto excretor es más largo, más ancho y tiene un ángulo casi vertical contra la gravedad, contribuyendo así a la estasis salival. Además, la secreción semimucosa de la misma es más viscosa. El sitio principal de ubicación de los litos en el conducto submandibular es la región hiliar con un 57 %. La sintomatología típica de la sialolitiasis es el cólico con tumefacción de la glándula y los dolores posprandiales. Reportamos el caso de un paciente masculino de 55 años, quien ingresa al servicio de Cirugía Oral y Maxilofacial del Hospital General Balbuena de la Ciudad de México por presentar un aumento de volumen en la región submandibular izquierda de consistencia dura y dolorosa a la palpación de 15 días de evolución, acompañada de aumento de temperatura en la zona compatible con un absceso. Los estudios de imagen reportan un sialolito en la región hiliar del conducto submandibular de 2,0 x 1,7 x 1,0 cm. Debido a su localización y tamaño, el tratamiento ideal en estos casos es la escisión de la glándula junto con el lito previo drenaje del absceso e inicio de terapia antibiótica doble.
Chronic sclerosing sialadenitis can range from focal sialadenitis to complete cirrhosis of the gland. It appears between 40 and 70 years of age and mainly affects the submandibular gland. It is associated with sialoliths and nonspecific infectious agents. The most common cause of sialolithiasis is the formation of macroscopically visible stones in a salivary gland or its excretory duct, of which 80 % to 90 % come from the submandibular gland. This predilection isprobably due to the fact that their excretory duct is longer, wider and has an almost vertical angle against gravity, thus contributing to salivary stasis. In addition, the semimucous secretion of it is more viscous. The main location of the stones in the submandibular duct is the hilar region with 57 %. The typical symptomatology of sialolithiasis is colic with swelling of the gland and postprandial pain. We report the case of a 55-year-old male patient, who was admitted to the Oral and Maxillofacial Surgery Service of the Hospital General Balbuena in Mexico City due to an increase in volumen in the left submandibular region that was hard and painful on palpation of 15 days of evolution, accompanied by increased temperature in the area compatible with an abscess. Imaging studies report a 2.0 x 1.7 x 1.0 cm sialolith in the submandibular duct hilar region. Due to its location and size, the ideal treatment in these cases is excision of the gland together with the stone previous drainage of the abscess and initiation of dual antibiotic therapy.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Sialadenite/diagnóstico por imagem , Glândula Submandibular/cirurgia , Tuberculose Bucal/diagnóstico por imagem , Sialadenite/tratamento farmacológico , Tuberculose Bucal/tratamento farmacológico , Ceftriaxona/uso terapêutico , Clindamicina/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Drenagem , Antibacterianos/uso terapêuticoRESUMO
We recently demonstrated that clindamycin exhibits activities in acute and chronic models of pain and inflammation. In the present study, we investigated the effects of clindamycin and a clindamycin acetylated derivative (CAD) in models of acute joint inflammation and in a microbiological assay. Joint inflammation was induced in mice by intraarticular (i.a.) injection of zymosan or lipopolysaccharide (LPS). Clindamycin or CAD were administered via the intraperitoneal route 1 h before zymosan or LPS. Paw withdrawal threshold, joint diameter, histological changes, neutrophil recruitment, tumor necrosis factor-α (TNF-α) production and phosphorylation of the IκBα and NF-κB/p65 were evaluated. In vitro assays were used to measure the antibacterial activity of clindamycin and CAD and also their effects on zymosan-induced TNF-α production by RAW264.7 macrophages. Clindamycin exhibited activity against Staphylococcus aureus and Salmonella Typhimurium ATCC® strains at much lower concentrations than CAD. Intraarticular injection of zymosan or LPS induced articular hyperalgesia, edema and neutrophil infiltration in the joints. Zymosan also induced histological changes, NF-κB activation and TNF-α production. Responses induced by zymosan and LPS were inhibited by clindamycin (200 and 400 mg/kg) or CAD (436 mg/kg). Both clindamycin and CAD inhibited in vitro TNF-α production by macrophages. In summary, we provided additional insights of the clindamycin immunomodulatory effects, whose mechanism was associated with NF-κB inhibition and reduced TNF-α production. Such effects were extended to a clindamycin derivative with reduced antibacterial activity, indicating that clindamycin derivatives should be investigated as candidates to drugs that could be useful in the management of inflammatory and painful conditions.
Assuntos
Artrite , NF-kappa B , Camundongos , Animais , Fator de Necrose Tumoral alfa/farmacologia , Hiperalgesia/induzido quimicamente , Hiperalgesia/tratamento farmacológico , Clindamicina/uso terapêutico , Clindamicina/farmacologia , Infiltração de Neutrófilos , Zimosan , Lipopolissacarídeos/farmacologia , Inflamação/induzido quimicamente , Antibacterianos/farmacologia , Edema/induzido quimicamente , Edema/tratamento farmacológicoRESUMO
La mastoiditis enmascarada es una forma poco frecuente dentro de las complicaciones de las otitis medias, ya sean aguda o crónicas. Su principal característica es presentar poca o mínima sintomatología ótica y tener un curso larvado en el tiempo. Este diagnóstico debe ser correctamente sospechado, ya que eventualmente puede generar consecuencias otológicas graves y presentar complicaciones mayores a nivel intra o extratemporal. En este trabajo se presenta el caso clínico de una paciente pediátrica sana, a la cual se diagnostica mastoiditis enmascarada de tres meses de evolución complicada con absceso de Bezold. Se inicia desde el ingreso hospitalario esquema antibiótico bi-asociado y se realiza mastoidectomía simple, evolucionando de forma satisfactoria.
Masked mastoiditis is a rare complication of acute or chronic otitis media. Its main characteristic is to present little or minimal otic symptoms and has a slowly progressive course over time. This diagnosis must be suspected correctly because it can eventually generate serious otological consequences and present major complications at intra or extratemporal levels. We report the clinical case of a healthy pediatric patient, who was diagnosed with masked mastoiditis complicated with a Bezold's abscess. A bi-associated antibiotic scheme was started from admission and a timpanomastoidectomy was performed, with a satisfactory outcome.
Assuntos
Humanos , Feminino , Criança , Otite Média/complicações , Mastoidite/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Clindamicina/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Cefotaxima/uso terapêutico , Mastoidite/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
Cutibacterium acnes has been associated with chronic prostatitis, which can potentially favor the appearance of tumors in the prostate. Prostatitis is difficult to treat, and the drug needs to be able to penetrate the prostate. The aim was to investigate the pharmacokinetics of clindamycin in the interstitial fluid of rat prostate using microdialysis. Microdialysis probes were recovered in vitro and in vivo. Clindamycin was administered at 80 mg/kg iv bolus for plasma and tissue pharmacokinetic experiments. A microdialysis probe was implanted in the prostate gland for collections over an 8-hour period. The pharmacokinetic parameters were determined by both compartmental and non-compartmental approaches. Penetration was determined as the ratio between the area under the curve and the time of the clindamycin measurement in the prostate. The recovery of the in vivo probes was 38.11 ± 1.14%. The plasma profile was modeled by a two-compartment pharmacokinetic model. Clindamycin presented a prostate/plasma ratio of 1.02, with free concentrations above the minimum inhibitory concentration for Cutibacterium acnes isolates. This was the first study that determined clindamycin free concentrations in the prostatic fluid of rats. These findings suggest that clindamycin may be an effective alternative for the treatment of prostatitis caused by Cutibacterium acnes.
Assuntos
Clindamicina , Prostatite , Animais , Antibacterianos/farmacologia , Clindamicina/farmacologia , Clindamicina/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Próstata , Prostatite/tratamento farmacológico , RatosRESUMO
BACKGROUND: Cefazolin is routinely recommended as the first-line agent for surgical antibiotic prophylaxis because it prevents more surgical site infections than second-line antibiotics. Clinicians often avoid administering cefazolin to patients who are labeled as penicillin allergic due to concerns of cross-reactivity. The aim of this study was to compare the incidence of hypersensitivity reactions between cefazolin and the second-line antibiotics vancomycin and clindamycin. METHODS: This retrospective study included patients who were labeled as penicillin allergic and received either cefazolin, clindamycin, or vancomycin as preoperative antibiotics. The primary outcome was intraoperative hypersensitivity reactions. RESULTS: A total of 734 surgical procedures in 690 patients were included. Fifteen immediate hypersensitivity reactions were identified. Probable hypersensitivity reactions occurred in 3 (0.9%) patients in the cefazolin group, 4 (1.4%) in the clindamycin group, and 1 (1.1%) in the vancomycin group. Seven of 8 patients reported allergies to additional medications beyond penicillin. There were seven cases of possible hypersensitivity reactions, 3 (0.9%) in the cefazolin group, 1 (1.1%) in the vancomycin group, and 3 (1.0%) in the clindamycin group. CONCLUSION: Our data suggest that perioperative hypersensitivity reactions are uncommon in patients labeled as penicillin allergic. The frequency of immediate hypersensitivity reactions was not different between patients receiving cefazolin, clindamycin, or vancomycin. Avoiding cefazolin in patients labeled as penicillin allergic may not be warranted.
Assuntos
Antibacterianos/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Cefazolina/efeitos adversos , Clindamicina/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade Imediata/induzido quimicamente , Penicilinas/efeitos adversos , Vancomicina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Cefazolina/uso terapêutico , Clindamicina/uso terapêutico , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Vancomicina/uso terapêuticoRESUMO
OBJECTIVE: To report the case of an infant with infrequent cranial osteomyelitis as a complication of furuncular myiasis. CASE DESCRIPTION: The patient was a 4-month-old male who presented to the emergency department with a nodular skull lesion with edema, tenderness, pain, and purulent drainage, as well as progress of the ulcerated lesion and evidence of larvae inside. Antibiotic treatment was initiated, and the patient was taken to the operating room to remove the larvae, but he had no symptomatic improvement. A skull radiograph was taken to visualize the osteolytic lesion, and a 3D computed tomography scan showed osteomyelitis of the external parietal surface. Antibiotic management readjustment continued for a total of six weeks, and a skin flap was used with clinical improvement. COMMENTS: Myiasis is defined as the infestation of vertebrates with fly larvae. In mammals, larvae can feed on host tissue and cause a wide range of infestations depending on their location in the body. The cranial osteomyelitis as a complication of myiasis described in this report seems to be an exceptional case.
Assuntos
Miíase/complicações , Miíase/parasitologia , Osteomielite/etiologia , Neoplasias Cranianas/parasitologia , Animais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antibióticos Antituberculose/administração & dosagem , Antibióticos Antituberculose/uso terapêutico , Clindamicina/administração & dosagem , Clindamicina/uso terapêutico , Terapia Combinada , Seguimentos , Humanos , Imageamento Tridimensional/instrumentação , Lactente , Larva/parasitologia , Masculino , Miíase/diagnóstico , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Alta do Paciente/normas , Radiografia/métodos , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Neoplasias Cranianas/patologia , Retalhos Cirúrgicos/transplante , Tomografia Computadorizada por Raios X/métodosRESUMO
ABSTRACT Objective: To report the case of an infant with infrequent cranial osteomyelitis as a complication of furuncular myiasis. Case description: The patient was a 4-month-old male who presented to the emergency department with a nodular skull lesion with edema, tenderness, pain, and purulent drainage, as well as progress of the ulcerated lesion and evidence of larvae inside. Antibiotic treatment was initiated, and the patient was taken to the operating room to remove the larvae, but he had no symptomatic improvement. A skull radiograph was taken to visualize the osteolytic lesion, and a 3D computed tomography scan showed osteomyelitis of the external parietal surface. Antibiotic management readjustment continued for a total of six weeks, and a skin flap was used with clinical improvement. Comments: Myiasis is defined as the infestation of vertebrates with fly larvae. In mammals, larvae can feed on host tissue and cause a wide range of infestations depending on their location in the body. The cranial osteomyelitis as a complication of myiasis described in this report seems to be an exceptional case.
RESUMO Objetivo: Relatar um caso de criança com osteomielite craniana infrequente como complicação da miíase furuncular. Descrição do caso: Paciente do sexo masculino, com quatro meses de idade, que se apresentou no pronto-socorro com lesão nodular no crânio com edema, sensibilidade, dor e drenagem purulenta, com evolução da lesão ulcerada e evidência de larva no interior. O tratamento com antibióticos foi iniciado e o paciente foi levado à sala de cirurgia para remover as larvas, mas não houve melhora. Uma radiografia do crânio foi realizada para visualizar a lesão osteolítica e uma tomografia computadorizada em 3D mostrou osteomielite da superfície parietal externa. O reajuste do tratamento com antibióticos foi mantido por um total de seis semanas e um retalho cutâneo foi realizado com melhora clínica. Comentários: Miíase é definida como a infestação de vertebrados com larvas de moscas. Nos mamíferos, as larvas podem se alimentar do tecido hospedeiro e causar uma ampla variedade de infestações, dependendo da sua localização no corpo. A osteomielite como complicação da miíase, apresentada nesse caso, parece ser uma forma não usual de complicação dessa doença.
Assuntos
Humanos , Animais , Masculino , Lactente , Osteomielite/etiologia , Neoplasias Cranianas/parasitologia , Miíase/complicações , Miíase/parasitologia , Osteomielite/tratamento farmacológico , Osteomielite/diagnóstico por imagem , Alta do Paciente/normas , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Neoplasias Cranianas/patologia , Retalhos Cirúrgicos/transplante , Clindamicina/administração & dosagem , Clindamicina/uso terapêutico , Radiografia/métodos , Tomografia Computadorizada por Raios X/métodos , Seguimentos , Terapia Combinada , Imageamento Tridimensional/instrumentação , Larva/parasitologia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Antibióticos Antituberculose/administração & dosagem , Antibióticos Antituberculose/uso terapêutico , Miíase/diagnósticoRESUMO
OBJECTIVE: Emergency department (ED) visits for the treatment of skin abscesses have increased with the emergence of community-associated methicillin-resistant Staphylococcus aureus (CAMRSA). There is limited information about the bacteriology of cutaneous abscesses evaluated in ED in Puerto Rico. The purpose of our study was to characterize the pathogens cultured from abscesses of patients in the ED consulted to the Dermatology Service of University of Puerto Rico School of Medicine. METHODS: Patients with skin abscesses consulted to the Dermatology Service by the ED of P.R. Medical Center from 2012 to 2017 were included. Data retrieved included demographic information, past medical history, prior antibiotic use, distribution of lesions, and treatment provided. Bacteriology results and antimicrobial susceptibility patterns from cultured skin lesions were recorded. RESULTS: Ninety patients diagnosed with skin abscess were evaluated. All patients underwent incision and drainage; this was the sole treatment in two patients. The most frequently administered systemic therapy was oral clindamycin in 32 patients (36%). A total of 66 patients (73%) had S. aureus isolates, most of them (85%) MRSA. Among the isolates with MRSA, 14.3% were resistant to clindamycin. All MRSA strains were susceptible to tetracycline and vancomycin. CONCLUSION: There is a high prevalence of MRSA causing abscesses in the Hispanic population evaluated in an ED in Puerto Rico. Systemic antibiotic use for the treatment of skin abscesses after incision and drainage remains high despite published guidelines arguing against their widespread use. Clindamycin resistance in our patient population appears to be more frequent than previously reported.
Assuntos
Abscesso/microbiologia , Dermatopatias Bacterianas/microbiologia , Abscesso/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Clindamicina/uso terapêutico , Dermatologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Porto Rico , Faculdades de Medicina , Dermatopatias Bacterianas/terapia , Staphylococcus aureus/isolamento & purificação , Tetraciclina/uso terapêutico , Vancomicina/uso terapêutico , Adulto JovemRESUMO
BACKGROUND: 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. SEARCH METHODS: 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. SELECTION CRITERIA: 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. DATA COLLECTION AND ANALYSIS: 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. MAIN RESULTS: 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; I2 = 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; I2 = 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 (RR 1.35, 95% CI 1.10 to 1.67; 133 women; moderate-quality evidence), compared to doxycycline. Regimens containing quinolone versus regimens containing cephalosporin The analysis shows there may be little or no clinically relevant difference between quinolones and cephalosporins in rates of cure for mild-moderate PID (RR 1.05, 95% CI 0.98 to 1.14; 4 RCTs, 772 women; I2 = 15%; low-quality evidence), or severe PID (RR 1.06, 95% CI 0.91 to 1.23; 2 RCTs, 313 women; I2 = 7%; low-quality evidence). We are uncertain whether there was a difference between quinolones and cephalosporins in adverse effects leading to discontinuation of treatment (RR 2.24, 95% CI 0.52 to 9.72; 6 RCTs, 1085 women; I2 = 0%; very low-quality evidence). Regimens with nitroimidazole versus regimens without nitroimidazole There was probably little or no difference between regimens with or without nitroimidazoles (metronidazole) in rates of cure for mild-moderate PID (RR 1.02, 95% CI 0.95 to 1.09; 6 RCTs, 2660 women; I2 = 50%; moderate-quality evidence), or severe PID (RR 0.96, 95% CI 0.92 to 1.01; 11 RCTs, 1383 women; I2 = 0%; moderate-quality evidence). The evidence suggests that there was little to no difference in in adverse effects leading to discontinuation of treatment (RR 1.05, 95% CI 0.69 to 1.61; 17 studies, 4021 women; I2 = 0%; low-quality evidence). . In a sensitivity analysis limited to studies at low risk of bias, there was little or no difference for rates of cure in mild-moderate PID (RR 1.05, 95% CI 1.00 to 1.12; 3 RCTs, 1434 women; I2 = 0%; high-quality evidence). Regimens containing clindamycin plus aminoglycoside versus quinolone We are uncertain whether quinolone have little to no effect in rates of cure for mild-moderate PID compared to clindamycin plus aminoglycoside (RR 0.88, 95% CI 0.69 to 1.13; 1 RCT, 25 women; very low-quality evidence). The analysis may result in little or no difference between quinolone vs. clindamycin plus aminoglycoside in severe PID (RR 1.02, 95% CI 0.87 to 1.19; 2 studies, 151 women; I2 = 0%; low-quality evidence). We are uncertain whether quinolone reduces adverse effects leading to discontinuation of treatment (RR 0.21, 95% CI 0.02 to 1.72; 3 RCTs, 163 women; I2 = 0%; very low-quality evidence). Regimens containing clindamycin plus aminoglycoside versus regimens containing cephalosporin We are uncertain whether clindamycin plus aminoglycoside improves the rates of cure for mild-moderate PID compared to cephalosporin (RR 1.02, 95% CI 0.95 to 1.09; 2 RCTs, 150 women; I2 = 0%; low-quality evidence). There was probably little or no difference in rates of cure in severe PID with clindamycin plus aminoglycoside compared to cephalosporin (RR 1.00, 95% CI 0.95 to 1.06; 10 RCTs, 959 women; I2= 21%; moderate-quality evidence). We are uncertain whether clindamycin plus aminoglycoside reduces adverse effects leading to discontinuation of treatment compared to cephalosporin (RR 0.78, 95% CI 0.18 to 3.42; 10 RCTs, 1172 women; I2 = 0%; very low-quality evidence). AUTHORS' CONCLUSIONS: We are uncertain whether one treatment was safer or more effective than any other for the cure of mild-moderate or severe PID Based on a single study at a low risk of bias, a macrolide (azithromycin) probably improves the rates of cure of mild-moderate PID, compared to tetracycline (doxycycline).