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O006 Is a short course of azithromycin effective in the treatment of mild to moderate Pelvic Inflammatory Disease (PID)?
  1. Gillian Dean1,
  2. Jennifer Whetham1,
  3. Suneeta Soni1,
  4. Louise Kerr1,
  5. Linda Greene2,
  6. Jonathan Ross3,
  7. Caroline Sabin4
  1. 1Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
  2. 2St Mary’s Hospital, Paddington, London, UK
  3. 3University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  4. 4Research Department of Infection and Population Health, UCL, London, UK


Background/introduction Crucial to treatment success in PID is adherence to therapy. All guidelines recommend 14-days of therapy although many women fail to complete 2-weeks, particularly if they experience side-effects. A shorter course of antibiotics may offer a valuable treatment alternative.

Aim(s)/objectives To compare clinical efficacy/acceptability of standard PID treatment 14-days with 5-day course of antibiotics for mild-moderate PID (pain for <30 days).

Methods A multicentre, open-label, non-inferiority RCT comparing arm-1 (ofloxacin/metronidazole) with arm-2 (azithromycin 1g day-1; 500mg od day-2–5, metronidazole/ceftriaxone). Efficacy was measured using standard pain-scores at baseline and 14–21 day follow-up looking for a 70% reduction; women who failed to complete treatment/return for follow-up were considered treatment failures.

Results N = 313 (152 arm-1, 162 arm-2 with similar baseline characteristics). Median age 25. Lower abdo-pain 95%, discharge 64%, dyspareunia 53%. Baseline pain-score median 8/36 (range 1–26); day 14–21 0/36 (range 0–18). Considering women who failed to complete therapy/return for follow-up as failures, the proportion with 70% pain reduction was 46.7% for arm-1; 42.2% for arm-2 (p = 0.49, difference in proportions (arm-2 minus arm-1) −4.5% (95% CI −15.5%, 6.5%)). For those women completing therapy the proportion with a 70% pain reduction was 68.9% for arm-1; 57.6% for arm-2 (p = 0.11, difference in proportions −11.3% (95% CI −23.9%, −1.3%). There were no significant differences in reported side effects except diarrhoea: 33.6% arm-1 vs 78.1% arm-2 (p = 0.0001).

Discussion/conclusion In terms of pain reduction we could not demonstrate that the shorter azithromycin course was non-inferior to the standard-of-care. Patients also experienced significantly more diarrhoea. This study highlights the importance of using evidence-based treatment regimens.

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