Comparing Ceftriaxone plus Azithromycin or Doxycycline for Outpatient Treatment in Pelvic Inflammatory Disease

Document Type : Original Article


1 Associate Professor of Obstetrics and Gynecology, Women's Health Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Assistant Professor of Obstetrics and Gynecology, Women's Health Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Resident of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Pelvic inflammatory disease is one of the most important complications of upper genital tract infections and common cause of infertility and chronic pelvic pain in women. One of the most common causes of PID is Chlamydia trachomatis. Azithromycin, have important role in treatment of genital Chlamydia infection and use of two doses of this drug is comparable with 14-days of Doxycycline. In this study, we compared the effect of these two drugs.
Methods: This clinical trial is carried out on 144 women with mild PID from April 2009 to May 2010 who were referred to Women's clinic of Imam Reza hospital and they are randomly divided into two groups (72 Cases in each group). One group was treated by Doxycycline 100mg/BID/14d and other group treated by oral Azithromycin 1g single dose that was repeated a week later. Both groups received single-dose of Ceftriaxone 250mg/IM. The partners of both groups took Ceftriaxone and Doxycycline. Pain and tenderness were evaluated in the MCPS & VAS system in the first, 7th and 14th day and were collected with personal details (age, parity, method of contraception, history of PID, employment status) in questionnaires. In this survey we used customary methods of descriptive statistic for introduction of research’s data, independent statistical T test and if abnormal, Man Whitney test for quantitative variants and x2 test for qualitative variants to compare two groups and analyze the results. Statistical analyses were done with SPSS version 13.
Results: Response to treatment occurred in 66 patients (91.7%) of the Azithromycin group and 64 patients (88.9%) in the Doxycycline group (p>0.05). Discontinuation of treatment was seen in 12 patients (14.3%) in Doxycycline group and no patient (0%) in the Azithromycin group (p<0.05).
Conclusion: Azithromycin regimen is better than Doxycycline regimen because of same response and only 2 doses instead of 28 doses.


1. Soper D. Genitourinary Infection and sexually transmitted disease. In : Berek J. Berek and novak's gynecology. 14 th
ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 541 – 560.
2. Eschenbach D. Pelvic and sexually transmitted infection. In: Gibbs R, Karlan B, Hanny A, Nygaard I. Danforth's
obstetrics and Gynecology. 10th ed. Philadelphia : wolters kluwer Health; 2008. p. 604 – 624.
3. Marten M. pelvic Inflammatory disease. In: Rock J,Jones III H. Te Linde's operative Gynecology. 10th ed.
Philadelphia: Wolters Health; 2008. p. 660 – 686.
4. Lau CY, Qureshi AK. Azithromycin versus doxycycline for genital chlamydial infection. Sex Transm Dis 2002 Sep;
29 (19): 497 – 502.
5. Martin DH, Mroczkowski TF, Dalu ZA, McCarty J, Jones RB, Hopkins SJ, et al. A controlled trial of a single dose of
azithromycin for the treatment of chlamydial urethritis and cervicitis. N Engl J Med 1992 Sep; 327 (13): 921 – 925.
6. Thorpe E, Stamm W, Hook E, Gall S, Jones K, Henry K, et al. Chlamydial cervicitis and urethritis: single dose
treatment compared with doxycycline for seven days in community based practices. Genitourin Med. 1996 Apr; 72
(2): 93 – 97.
7. Senday F, Terek C, Tuncay G, Ozkinay E, Guven M. Single dose oral azithromycin versus seven day doxycycline in
the treatment of non – gonococcal mucopurulent endocervicitis. Aust N Z J Obstet Gynaecol 2000 Feb; 40 (1): 44 –
8. Tan H, Chan R. An open label comparative study of azithromycin and doxycycline in the treatment of non –
gonococcal urethritis in males and Chlamydia trachomatis cervicitis in female sex workers in an STD clinic in
Singapore. Singapore Med J 1999 Aug; 40 (8): 519 – 523.
9. Sahin Hodoglugil N, Woods R, Pettifor A, Walsh J. A Comparison of cost – effectiveness of three protocols for
diagnosis and treatment of gonococcal and Chlamydial infections in women in Africa .Sex Transm Dis 2003 May; 30
(5): 455 – 469.
10. Lea A, Lamb H. A Pharmacoeconomic review of its use as a single dose regimen in the treatment of uncomplicated
urogenital Chlamydia trachomatis infection in women. Pharmacoeconomics 1998 Jun; 13 (16): 696.
11. Magid D, John M, Douglas Jr, Sanford J. Doxycycline compared with azithromycin for treating women with genital
Chlamydia treachomatis infection. Obst and Gyn survey 1996 Sep; 51 (9): 532 – 533.
12. Grecek M, Maieron A, Strau R, Wieninger P, Apfater P, Mittermayer H. Ten years of antibiotic consumption in
ambulatory care. BMC Infect Dis 2009 May; 13(9): 61.
13. Savaris R, Teixeira L, Torres T, Edelweiss M, Moncada J, Schahter J. Comparing ceftriaxone plus azithromycin or
doxycycline for pelvic inflammatory disease. Obstet and Gynecol 2007 July; 110 (1) 53 – 60.
14. Haggerty C, Ness R. Newest Approaches to treatment of pelvic inflammatory disease. Clin Infect Dis 2007 Apr; 44
(7): 953 – 96.