Azithromycin for PID beats doxycycline on all counts

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PURLs

Azithromycin for PID beats doxycycline on all counts

J Fam Pract. 2007 December;56(12):1006-1008

References

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2. Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the pelvic inflammatory disease evaluation and clinical health (PEACH) randomized trial. Am J Obstet Gynecol 2002;186:929-937.

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6. Centers for Disease Control and Prevention. Update to CDC sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep 2007;56(14):332-336.Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5614a3.htm. Accessed on November 14, 2007.

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Adherence similar in both groups

Adherence to the study protocol was similar in both groups. The study authors concluded that azithromycin was superior to doxycycline even though the adherence in the doxycycline group was good.

What’s new?: Better adherence is the probable bonus

This RCT shows that azithromycin treatment of PID in an ambulatory population is superior to doxycycline even when there is excellent compliance with taking doxycycline (unlike the reality of clinical practice). The patients in this RCT adhered well to the protocol, so it does not provide a realistic head-to-head comparison of treatment completion.

Real-world adherence

In actual practice, we speculate that taking 2 pills 1 week apart will be much easier for patients than taking 2 pills every day for 14 days. The literature on compliance would predict that to be the case. If true, then the advantage of azithromycin over doxycycline would be even greater than reported in this study.

Caveats: Apply these findings in similar cases only

This study addresses ambulatory treatment of mild, uncomplicated PID, and results should only be extrapolated to similar cases.

Azithromycin should not be prescribed to patients with an allergy to macrolide antibiotics.

One of the study authors received azithromycin donated by Pfizer for other research; however, Pfizer did not sponsor this study.

Challenges to implementation: Cost of the prescription

Prescription cost may be a consideration for patients without insurance, although azithromycin has been shown to be cost-effective in treatment of Chlamydia.¹²

Reminding patients to take the second dose

Some patients may have difficulty remembering to take the second dose a week after the first dose.

A follow-up visit, reminder phone call, or suggestion to “mark this on your calendar” may help enhance adherence.

PURLs methodology

This study was selected and evaluated using the Family Physician Inquiries Network’s Priority Updates from the Research Literature Surveillance System (PURLs) methodology. The criteria and findings leading to the selection of this study as a PURL can be accessed here.