Summary of findings 3.
Nitroimidazole compared to no nitroimidazole for pelvic inflammatory disease
| Nitroimidazole compared to no nitroimidazole for pelvic inflammatory disease | ||||||
|
Population: women with PID Setting: hospital ward or outpatient clinic Intervention: nitroimidazole Comparison: no use of nitroimidazole | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of women (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with no use of nitroimidazole | Risk with nitroimidazole | |||||
|
Clinical cure according to criteria established by study authors Mild‐moderate PID Follow‐up: range 14‐28 days |
925/1214 762 per 1000 |
949/1213 782 per 1000 (758 to 804) |
RR 1.01 (0.93 to 1.10) NNTB 19 to NNTH 77 |
2427 (5 RCTs) | ⊕⊕⊕⊝ Moderate1,2 | ‐ |
|
Clinical cure according to criteria established by study authors Mild‐moderate PID Follow‐up: range 14‐28 days Sensitivity analysis restricted to studies at low risk of bias |
452/606 746 per 1000 |
470/595 790 per 1000 (755 to 820) |
RR 1.06 (0.98 to 1.15) NNTB 11 to NNTH 266 |
1201 (2 RCTs) |
⊕⊕⊕⊕ High |
‐ |
|
Clinical cure according to criteria established by study authors Severe PID Follow‐up: range 14‐28 days |
573/689 832 per 1000 |
558/694 804 per 1000 (772 to 831) |
RR 0.96 (0.92 to 1.01) NNTB 15 to NNTH 76 |
1383 (11 RCTs) | ⊕⊕⊕⊝ Moderate1 | ‐ |
|
Adverse events: any antibiotic‐related adverse event leading to discontinuation of therapy Follow‐up: mean 14 days |
34/1911 18 per 1000 |
33/1910 17 per 1000 (12 to 24) |
RR 1.00 (0.63 to 1.59) NNTB 110 to NNTH 125 |
3821 (16 RCTs) | ⊕⊕⊝⊝ Low1,3 | 10/16 studies (1088 women) did not contribute data to the analysis because the authors reported no events. |
| *The risk in the intervention group (and its 95% confidence interval) is based on the mean risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; NNTB: number needed to treat for an additional beneficial outcome; NNTH: number needed to treat for an additional harmful outcome; PID: pelvic inflammatory disease; RCT: randomized controlled trial; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect. | ||||||
1 Downgraded one level for serious risk of bias (poor reporting of methods and high or unclear risk of performance and detection bias in one or more studies).
2 Substantial inconsistency (I2 = 50%). Not downgraded because all inconsistency related to a single small study (30 women) which barely influenced the overall estimate.
3 Downgraded one level for serious imprecision: confidence intervals compatible with benefit in one or both groups, or with no difference between the groups, only 68 events overall.