How Important Is Anaerobic Coverage for Managing Pelvic Inflammatory Disease?

Although pelvic inflammatory disease (PID) is most often triggered by infection with gonococcus or chlamydia, many other bacteria — predominantly anaerobes — also play a role. To clarify the role of metronidazole (an antibiotic with activity solely against anaerobes) in the management of PID, investigators randomized 233 women with clinical diagnoses of PID to receive oral metronidazole (500 mg twice daily) or placebo for 2 weeks; all women also received intramuscular ceftriaxone (250-mg single dose) and oral doxycycline (100 mg twice daily for 2 weeks).

At 3 days, clinical improvement was seen in >90% of participants in both groups. At 30 days, 97% of women in the metronidazole group, compared with 90% of those in the placebo group, were de…