| Study | Reason for exclusion |
|---|---|
| Acar 1989 | Results not separate for PID. |
| Andersson 1980 | Quasi‐RCT and not randomized to doxycycline. |
| Bartlett 1982 | Not an RCT. |
| Berkeley 1986 | Results not separate for PID. |
| Blanco 1983 | Results not separate for PID. |
| Brihmer 1988 | Did not report effectiveness or safety outcomes. |
| Brihmer 1989 | Not a comparison of interest. Group A: doxycycline 200 mg IV the first day, followed by 100 mg PO daily for 10 days + benzylpenicillin‐procaine 2.25 millions IM twice daily for 2 days. Group B: trimethoprim 160 mg + sulfamethoxazole 800 mg IV twice daily the first day, followed by 800 mg PO for 10 days. |
| Bruhat 1986 | Not a comparison of interest. Group A: sulbactam 2 g daily IV + ampicillin 4 g daily for 5 days, followed by 15 days of sulbactam IM + ampicillin 2 g daily (n = 9) Group B: cefoxitin 6 g daily IV for 5 days, followed by 15 days of cefoxitin 2 g daily IM (n = 11) In both groups, if there was evidence of chlamydial infection, doxycycline 200 mg PO daily for 30 days given. |
| Bruhat 1989 | Not a comparison of interest. Group A: sulbactam 2 g daily IV + ampicillin 4 g daily for 5 days, followed by 15 days of sulbactam IM + ampicillin 2 g daily (n = 20) Group B: cefoxitin 6 g daily IV for 5 days, followed by 15 days of cefoxitin 2 g daily IM (n = 20) |
| Bruno 1985 | Not an RCT |
| Carty 1973 | Not antibiotic |
| Chatwani 1997 | Not a comparison of interest. Group A: trospectomycin 500 mg IV every 8 h for at least 4 days of inpatient treatment and had achieved complete resolution of sign and symptoms of acute PID, followed by 10 days of doxycycline PO (n = 26) Group B: cefoxitin 2 g every 6 h + doxycycline 100 mg PO or IV for at least 4 days of inpatient treatment and had achieved complete resolution of sign and symptoms of acute PID, followed by 10 days of doxycycline PO (n = 13) |
| Confino 1988 | Did not report effectiveness or safety outcomes |
| De Beer 1983 | Not a comparison of interest. Group A: ampicillin 2 g IV on admission and then 1 g IV every 4 h thereafter. If the response was good, ampicillin was administered PO after 48 h. Group B: cefoxitin 2 g IV followed by 1 g IV every 8 h. This was continued for at least 72 h. |
| Drasa 2010 | Results not separate for PID. |
| Drusano 1982 | Results not separate for PID |
| Duarte 1995 | Not an RCT. |
| Faro 1988 | Not a comparison of interest. Group A: ceftizoxime 2 g IV every 8 h for at least 5 days (n = 18) Group B: cefotaxime 2 g IV every 8 h for at least 5 days (n = 19) |
| Fedele 1989 | Not PID. |
| Frongillo 1992 | Results not separate for PID. |
| Gall 1981 | Not all participants randomized. |
| Gall 1990a | Not an RCT. |
| Gall 1990b | Not a comparison of interest. Group A: clindamycin 900 mg + tobramycin 80 mg/m2 IV every 8 h for at least 4 days. Group B: clindamycin 900 mg + placebo IV every 8 h for at least 4 days. Both treatment were followed by clindamycin 450 mg PO every 6 h, to complete 14 days of treatment. |
| Gerber 1992 | Not a comparison of interest. Group A: oxytetracycline 4 × 0.5 g PO daily or doxycycline 2 × 0.1 g PO daily, initially IV + metronidazole first 2 days 2 × 0.5 g IV from day 3, 2 × 0.25 g PO daily). Group B: oxytetracycline 4 × 0.5 g PO daily or doxycycline 2 × 0.1 g PO daily, initially IV + metronidazole first 2 days 2 × 0.5 g IV from day 3, 2 × 0.25 g PO daily) + additional bathing therapy. Group C: amoxicillin‐clavulanic acid 1st + 2nd day 1.2 g daily IV, 3rd to 10th day 3 × 0.75 g PO daily. Group D: ciprofloxacin initial 2 × 0.2 g IV then to day 10 2 × 0.5 g PO daily + metronidazole 1st and 2nd day 2 × 0.5 g day IV from day 3, 2 × 0.25 g PO daily. |
| Gerstner 1990 | Results not separate for PID. |
| Ghomian 2012 | Many inconsistencies in the study, author did not respond. |
| Giamarellou 1982 | Results not separate for PID. |
| Gibbs 1980a | Not a comparison of interest. Group A: penicillin G 5 x 106 units IV every 6 h + kanamycin 500 mg IM every 12 h for 4‐7 days after good clinical response (n = 5). Group B: spectinomycin 500 mg IM every 12 h for 4‐7 days after good clinical response (n = 7). |
| Gjonnaess 1981 | Not all participants randomized. |
| Grafford 1980 | Not a comparison of interest. Group A: bacampicillin 400 mg PO 3 times daily for 14 days (n = 39). Group B: bacampicillin 800 mg PO 3 times daily for 14 days (n = 31). |
| Grafford 1981 | Not an RCT. |
| Gunning 1986a | Not a comparison of interest. Group A: piperacillin 250 mg/kg daily IV divided into every 6 h for 5‐11 days (n = 31). Group B: clindamycin 600 mg IV 6/6 h + gentamicin 1.5 mg/kg IV every 8 h for 3‐8 days (n = 33). |
| Gunning 1986b | Not a comparison of interest. Group A: sulbactam 1 g + ampicillin 2 g IV every 6 h until asymptomatic and without clinical signs or pathogen sensitivity testing dictated a change in therapy (n = 21). Group B: clindamycin 600 mg IV 6/6 h + gentamicin 1.5 mg/kg IV every 8 h until asymptomatic and without clinical signs or pathogen sensitivity testing dictated a change in therapy (n = 18). |
| Hager 1989 | Not PID. |
| Harding 1982 | Not PID. |
| Harding 1984 | Not PID. |
| Hemsell 1982 | Results not separate for PID. |
| Hemsell 1987 | Not an RCT. |
| Hemsell 1988a | Authors report data without details of clinical cure |
| Hemsell 1988b | Results not separate for PID. |
| Hemsell 1988c | Not a comparison of interest. Group A: cefoxitin 2 g IV every 6 h + doxycycline 100 mg every 12 h for minimum of 4 days and for at least 48 h after defervescence, followed by doxycycline 100 mg PO when discharged from the hospital to complete 14 days of therapy (n = 32). Group B: ceftizoxime 2 g IV every 12 h + doxycycline 100 mg was given separately in 250 mL diluent and infused over 2 h for minimum of 4 days and for at least 48 h after defervescence, followed by doxycycline 100 mg PO when discharged from the hospital to complete 14 days of therapy (n = 30). Group C: ceftizoxime 2 g IV 3 times daily every 8 h for minimum of 4 days and for at least 48 h after defervescence (n = 29). Group D: ceftizoxime 2 g IV twice daily every 12 h for minimum of 4 days and for at least 48 h after defervescence (n = 30). |
| Hemsell 1988d | Results not separate for PID. |
| Hemsell 1990 | Not a comparison of interest. Group A: ampicillin 2 g + sulbactam 1 g IV every 6 h. Women whose treatment was successful received therapy for a mean (± SD) of 4.5 ± 0.9 days (n = 35). Group B: cefoxitin 2 g IV every 6 h. Women whose treatment was successful received therapy for a mean (± SD) of 4.5 ± 0.9 days (n = 19) |
| Hemsell 1991 | Did not report effectiveness or safety outcomes. |
| Hemsell 1993 | Not a comparison of interest. Group A: ampicillin/sulbactam 3 g IV every 6 h on at least 4 consecutive days and until the woman was afebrile for at least 48 h. Women with C trachomatis at study entry received doxycycline 100 mg PO twice daily for 10‐14 days when discharged from hospital. Women negative for C trachomatis discharged on no oral antibiotic (n = 76). Group B: cefoxitin 2 g IV every 6 h on at least 4 consecutive days and until the woman was afebrile for at least 48 h. Women with C trachomatis at study entry received doxycycline 100 mg PO twice daily for 10‐14 days when discharged from hospital. Women negative for C trachomatis discharged on no oral antibiotic (n = 41). |
| Hemsell 1997 | Not a comparison of interest. Group A: meropenem 500 mg IV given over 20‐30 minutes every 8 h for at least 48 h, for clinical evaluation (suggested treatment duration 4‐10 days, with a maximum duration of 28 days). Group B: clindamycin 900 mg IV + gentamicin 1.5 mg/kg following a loading dose of 2.0 mg/kg every 8 h for at least 48 h, for clinical evaluation (suggested treatment duration 4‐10 days, with a maximum duration of 28 days). |
| Henry 1985 | Not a comparison of interest. Group A: aztreonam 1‐2 g every 8‐12 h. Most women received 1 or 2 g 3 times daily. Clindamycin (usually at a dosage of 600 mg every 8 h) administered concurrently with aztreonam as a means of providing coverage against Gram‐positive and anaerobic organisms (n = 50; 5 with PID). Group B: gentamicin 3‐5 mg/kg daily in 3 equally divided doses + clindamycin 600 mg every 8 h (n = 38; 8 with PID). In both groups, antibiotics usually administered IM or IV; however, PO administration of clindamycin was permitted. |
| Holloway 1988 | Results not separate for PID. |
| Ibrahim 1990 | Not a comparison of interest. Group A: amikacin 14 mg/kg IV infusion in 150 mL saline over 30 minutes once daily. Treatment administered for 7‐9 days. Group B: amikacin 14 mg/kg IV infusion in 150 mL saline over 30 minutes twice daily. Treatment administered for 7‐9 days. Group C: netilmicin 6.6 mg/kg IV infusion in 150 mL saline over 30 minutes once daily. Treatment administered for 7‐9 days. Group D: netilmicin 6.6 mg/kg IV infusion in 150 mL saline over 30 minutes 3 times daily. Treatment administered for 7‐9 days. All 4 groups also received tinidazole 0.8 g once daily + ampicillin 4 g daily. |
| Jemsek 1997 | Not a comparison of interest. Group A: minimum 12 doses = 3 days of ampicillin 2 g/sulbactam 1 g IV every 6 h. Group B: minimum 12 doses = 3 days of cefoxitin 2 g IV every 6 h. Doxycycline 100 mg PO or IV twice daily administered concurrently to women with cultures positive for C trachomatis. Because of the significant possibility of false negatives, women with cultures negative for C trachomatis were empirically treated with 10‐14 days of doxycycline 100 mg PO twice daily after the study ended. |
| Jordheim 1974 | Not a comparison of interest. Group A: pivampicillin 175 mg PO capsule 4 times daily for 0‐4/5‐9/10‐14/15‐19 days (n = 28) Group B: pivampicillin 350 mg PO capsule 4 times daily for 0‐4/5‐9/10‐14/15‐19 days (n = 30) In some cases, duration of therapy was longer or shorter depending on clinical response. |
| Judlin 1995 | Not a comparison of interest. Group A: ofloxacin 400 mg daily in 2 × 200 mg tablets morning and night; amoxicillin‐clavulanic acid 2 g daily, 2 × 500 mg tablets morning and night. Combination given for 3 weeks. Group B: doxycycline 200 mg daily, 1 × 100 mg tablet morning and night; amoxicillin‐clavulanic acid 2 g daily, 2 × 500 mg tablets morning and night. Combination given for 6 weeks. |
| Knupell 1988 | Not a comparison of interest. Group A: cefotetan 2 g IV every 12 h, mean duration of therapy 6.1 days (n = 36). Group B: cefoxitin 2 g IV every 6 or 8 h, mean duration of therapy 6.4 days (n = 17). |
| Kosseim 1991 | Not a comparison of interest. Group A: ampicillin‐sulbactam 750 mg PO twice daily for 10 days (n = 38). Group B: cefoxitin 2 g IM + probenecid 1 g PO, followed by doxycycline 100 mg twice daily for 10 days (n = 37). |
| Kotoulas 1992 | Not an RCT. |
| Kunzig 1990 | Results not separate for PID. |
| Kvile 1980 | Compared same drug with different doses. |
| Larsen 1986 | Results not separate for PID. |
| Larsen 1992 | Not a comparison of interest. Group A: imipenem‐cilastatin 500 mg IV every 6 or 8 h. Treatment continued for at least 3 days or until the woman was afebrile for 24‐48 h (n = 44). Group B: clindamycin 900 mg IV every 8 h + gentamicin 1.5 mg/kg IV or IM for first dose, and 1.0 mg/kg every 8 h for succeeding doses. Treatment continued for at least 3 days or until the woman had been afebrile for 24‐48 h (n = 50). In both treatments, if therapy for Chlamydia spp was indicated, doxycycline 100 mg PO or IV added to either regimen every 12 h. |
| Livengood 1992 | Not a comparison of interest. Group A: clindamycin 600 mg IV every 6 h + cefamandole 2 g every 6 h. Group B: clindamycin 600 mg IV every 6 h + doxycycline 100 mg + 10 mL of 4% sodium bicarbonate alternating with placebo (5% dextrose in water) every 6 h. Protocol antibiotic therapy continued for 48 h after declaration of response and for minimum of 5 days (20 doses), after which women discharge without supplemental oral antibiotic treatment. |
| Ma 2010 | Not a comparison of interest. Group A: levornidazole 0.5 g twice daily for 5‐7 days. Group B: ornidazole 0.5 g twice daily for 5‐7 days. |
| Maggioni 1998 | Results not separate for PID. |
| Maki 1979 | Not PID. |
| Mandell 1993 | Results not separate for PID. |
| Marier 1982 | Not a comparison of interest. Group A: piperacillin 250 mg/kg daily IV every 4‐6 h. Group B: carbenicillin 450 mg/kg daily IV every 4‐6 h. |
| Marshall 1982 | Not PID. |
| Matsuda 1988 | Not a comparison of interest. Group A: cefpodoxime proxetil 100 mg tablet + dummy bacampicillin placebo, twice daily. Alternately, dummy CS‐807 + dummy bacampicillin, twice daily; therefore, women took tablets 4 times daily for 7 consecutive days. Group B: bacampicillin 250 mg tablet + dummy cefpodoxime proxetil placebo, 4 times daily for 7 consecutive days. |
| Matsuda 1989 | Not a comparison of interest. Group A: ceftibuten 100 mg 3 times daily. The shape of 2 tablets (7432‐S, bacampicillin) was different, so women took 8 tablets daily (after meal and before sleep) with placebo. At least 3‐day administration when a primary physician found cure of the infection, or assessed no efficacy and need to change a different drug. Group B: bacampicillin 250 mg 4 times daily. The shape of 2 tablets (7432‐S, bacampicillin) was different, so women took 8 tablets daily (after meal and before sleep) with placebo. At least 3‐day administration when a primary physician found cure of the infection, or assessed no efficacy and need to change a different drug. |
| Moghtadaei 2008a | Risk of fraud, no reply from author. |
| Moghtadaei 2008b | Risk of fraud, no reply from author. |
| Ness 2002 | Compared the same drugs as inpatient versus outpatient. |
| Ness 2005 | Not a comparison of interest. Group A: inpatient strategy cefoxitin 2 g IV every 6 h + doxycycline 100 mg IV or PO twice daily for at least 72 h, followed by doxycycline 100 mg PO twice daily for a total 14‐day course. Group B: outpatient treatment consisted of cefoxitin 2 g IM + probenecid 1 g PO, followed by doxycycline 100 mg PO twice daily for 14 days. |
| Nicolle 1986 | Not PID. |
| Paavonen 1985 | Did not report effectiveness or safety outcomes. |
| Pastorek 1985 | Results not separate for PID. |
| Roy 1998 | Not PID. |
| Ruiz Conde 1999 | Results not separate for PID. |
| Sanfilippo 1989 | Not a comparison of interest. Group A: mezlocillin 250 mg daily every 6 h + appropriate IV solution containing no antibiotic but identical in appearance to tobramycin solution every 8 h. Group B: aqueous crystalline penicillin G 480,000 U/kg every 6 h (maximum of 20 million units daily) + tobramycin 3 mg/kg daily every 8 h. Dose of tobramycin was then adjusted according to peak and rough blood levels to keep tobramycin levels within therapeutic range. Another physician, not directly involved with clinical management, evaluated tobramycin levels and contacted the pharmacy for changes of tobramycin levels. |
| Schnider 1979 | Not a comparison of interest. Group A: penicillin G 30 million units daily + netilmicin 2 mg/kg daily parenterally over 5 days. Group B: penicillin G 30 million units daily + gentamicin 3 mg/kg daily parenterally over 5 days. |
| Senft 1986 | Results not separate for PID. |
| Sesti 1990 | Not an RCT. |
| Sharma 2007 | Not a comparison of interest. Group A: ofloxacin 400 mg/ornidazole 500 mg/Saccharomyces boulardii (2 million spores)/lactic acid bacillus (60 million spores)/serratiopeptidase 10 mg once daily for total of 10 days (n = 98). Group B: doxycycline 100 mg twice daily + metronidazole 400 mg 3 times daily + serratiopeptidase 10 mg once daily for total of 10 days (n = 95). |
| Silva 1990 | Results not separate for PID. |
| Skerk 2003 | Compared same drug with different doses. |
| Spence 1981 | Not a comparison of interest. Group A: ampicillin 2 g IV every 4 h for minimum of 96 h followed by 0.5 g PO every 6 h to complete 10 days of treatment. Group B: doxycycline 200 mg IV initially, then 100 mg IV every 12 h for at least 96 h followed by 100 mg PO every 12 h to complete 10 days of treatment. |
| Stamm 1984 | Not PID. |
| Stiglmayer 1996 | Not a comparison of interest. Group A: sulbactam 1 g + ampicillin 2 g IV every 8 h. Group B: cefoxitin 2 g IV every 8 h. |
| Sweet 1988 | Not a comparison of interest. Group A: cefotetan 2 g IV every 12 h + doxycycline 100 mg IV every 12 h. Group B: cefoxitin 2 g IV every 6 h + doxycycline 100 mg IV every 12 h. Both treatments had a minimum of 4 days, at least for 48 h after disappearance of fever, after hospital discharge, doxycycline 100 mg PO every 12 h to complete 14 days of treatment. |
| Sweet 1994 | Results not separate for PID. |
| Takase 1986 | Not a comparison of interest. Group A: ofloxacin 1 dose 200 mg 3 times daily for 7 days. Group B: amoxicillin 1 dose 250 mg 4 times daily for 7 days. |
| Tellado 2002a | Not an RCT. |
| Tellado 2002b | Not an RCT. |
| Teppler 2002 | Not an RCT. |
| Thompson 1980 | Not a comparison of interest. Group A: aqueous penicillin G, 5 million units IV every 4 h + gentamicin 60 mg or 80 mg IV every 8 h based on weight. Group B: amoxicillin 1 g PO every 4 h. If the woman could not take oral medicines she received ampicillin 1 g IV every 4 h, until she could be changed to oral amoxicillin. She was switched as soon as possible to ampicillin 2 g PO daily if on regimen A, or amoxicillin 2 g PO daily if on regimen B, to complete 10 consecutive days of antibiotic treatment. |
| Thompson 1985 | Not a comparison of interest. Group A: aqueous procaine penicillin G, 4.8 million units IM + probenecid 1 g PO, followed by ampicillin monohydrate 0.5 g PO 4 times daily for 10 days. Group B: tetracycline hydrochloride 1.5 g PO as a single loading dose, followed by tetracycline 0.5 g PO 4 times daily for 10 days. |
| Tulkens 1988 | Not a comparison of interest. Group A: netilmicin 6.6 mg/kg IV once daily + tinidazole 0.8 g daily (once daily) + ampicillin 4 g daily (twice daily) for mean duration of 7 days. Group B: netilmicin 2.2 mg/kg IV 3 times daily + tinidazole 0.8 g daily (once daily) + ampicillin 4 g daily (twice daily) for a mean duration of 7 days. |
| Tulkens 1991 | Not an RCT. |
| Van Gelderen 1987 | Not a comparison of interest. Group A: ceftriaxone 2 g IV once daily for 2 days followed by 1 g once daily for the next 2‐8 days. Group B: penicillin G sodium 4200 mg IV + chloramphenicol 500 mg 4 times daily for 4‐10 days. Additional treatment: because there was a strong suspicion that anaerobic bacteria (which were not isolated specifically) were present, 5 ceftriaxone‐treated women and 8 penicillin/chloramphenicol‐treated women also received nitroimidazole 400‐500 mg every 8 h. |
| Walker 1991 | Not a comparison of interest. Group A: cefotetan 2 g IV every 12 h + doxycycline 100 mg IV every 12 h for minimum of 4 days and for at least 48 h after clinical response, followed by doxycycline 100 mg PO every 12 h was continued to complete a 14‐day course after the woman was discharged (n = 54). Group B: cefoxitin 2 g IV every 6 h + doxycycline 100 mg IV every 12 h for minimum of 4 days and for at least 48 h after clinical response, followed by doxycycline 100 mg PO every 12 h was continued to complete a 14‐day course after the woman was discharged (n = 54). |
| Wikler 1989 | Not a comparison of interest. Group A: ceftizoxime 2 g every 12 h. Group B: ceftizoxime 2 g every 8 h. Group C: ceftizoxime 2 g + doxycycline 100 mg every 12 h. Group D: cefoxitin 2 g every 6 h + doxycycline 100 mg every 12 h. Women receiving IV doxycycline continued to receive doxycycline 100 mg PO every 12 h after discharge from hospital for a total duration of 14 days (IV + PO therapy). |
| Witte 1993 | Not a comparison of interest. Group A: pefloxacin 800 mg daily + metronidazole 500 mg every 8 h. Group B: doxycycline initial dose of 200 mg followed by 100 mg daily + metronidazole 500 mg every 8 h. For both group A and B, the duration of treatment was at least 10 days, and maximal 14 days, unless the clinical response was considered insufficient after 5 days. The minimal duration of therapy to allow efficacy assessment was 5 days. |
| Wynd 1999 | Cost‐effectiveness study comparing ampicillin/sulbactam versus cefoxitin for the treatment of PID |
h: hour; IM: intramuscular; IV: intravenous; PID: pelvic inflammatory disease; PO: per os; RCT: randomized controlled trial; SD: standard deviation.