Doxycycline monotherapy first line treatment for Chronic Endometritis: Study
Researchers have determined in a new study that doxycycline monotherapy can actually be the first-line therapy of choice for chronic endometritis (CE), as it is as effective as a levofloxacin-tinidazole combination but produces fewer side effects. CE is a chronic inflammation of the endometrium with a low rate of spontaneous cure, necessitating usually antibiotic treatment for improvement. The most commonly employed antibiotic regimens for CE are doxycycline monotherapy or the combination of levofloxacin and tinidazole. This study was published in the American Journal of Obstetrics and Gynecology by Yue Liu and colleagues.
The objective of this study was to compare the efficacy and safety of doxycycline monotherapy with that of levofloxacin co-administered with tinidazole in the treatment of patients diagnosed with CE using CD138 immunohistochemistry.
A parallel randomized controlled trial was conducted, involving 172 CE-diagnosed patients. The patients were divided into two groups after randomization: the intervention group was given levofloxacin together with tinidazole, while the control group was given doxycycline as a single therapy. Follow-up assessment consisted of multiple hysteroscopy and endometrial biopsy during the first proliferative phase of menstruation after treatment, cure being the change of CD138 expression from positive to negative. Rates of cure and rates of adverse reaction were examined by per-protocol and intent-to-treat analysis.
Results
Of 172 patients, 160 were followed up, 79 in the treatment arm and 81 in the control arm.
A cure rate after one course of therapy was 84.8% in the treatment arm and 77.8% in the doxycycline arm with no statistically significant difference (P = 0.255).
Subgroup analysis indicated there was no cure rate difference between groups for mild CE (88.9% vs. 83.7%, P = 0.464) or severe CE (79.4% vs. 68.8%, P = 0.322).
On intent-to-treat analysis (n = 172), cure rates were 77.9% (67/86) in the treatment group and 73.3% (63/86) in the doxycycline group (P = 0.595).
But the frequency of adverse reactions was much greater in the treated group than in the doxycycline group (11.6% vs. 2.3%, P < 0.05), suggesting a superior safety profile for monotherapy with doxycycline.
Both doxycycline monotherapy and levofloxacin-tinidazole combination were efficacious for the treatment of chronic endometritis. There was no statistically significant cure rate difference between both regimens. Due to the reduced rate of adverse effects, doxycycline monotherapy is preferable as the first-line antibiotic treatment of CE.
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