Meta-analysis of fluoroquinolone antibiotics in the treatment of pelvic inflammatory disease and associated risk factors

Pelvic inflammatory disease (PID) is a common infectious disease affecting the female reproductive organs and surrounding tissues. Antibiotics remain a cornerstone of current treatment regimens. This work aimed to systematically assess efficacy of fluoroquinolone antibiotics in the treatment of PID through meta-analysis (MA). Randomized controlled trials (RCTs) on fluoroquinolone antibiotics for uncomplicated PID were retrieved from online databases up to July 8, 2024. Statistical analysis was conducted using RevMan5.2, focusing on WBC count, CRP levels, clinical efficacy, and adverse reactions (ARs), with outcomes measured by odds ratios (ORs) and 95% confidence intervals (CIs). Fourteen studies were included, comprising a total of 2483 patients with PID, of whom 1244 received fluoroquinolone antibiotics (experimental group - EG). All patients received treatment for 7 to 14 days. After treatment, the EG showed significantly lower WBC and CRP levels compared to the control group (CG), with both differences statistically significant (P < .00001, 5 studies; I2 = 0% for WBC; I2 = 0% for CRP). The cure rate in EG was 66.43% (663/998), which was higher than the CG cure rate of 62.42% (623/998) (P < .05, 9 studies; I2 = 42%). The incidence rates of abdominal pain (3.89%, 18/463), nausea and vomiting (17.13%, 168/981), and overall adverse reactions (35.22%, 273/775) were all lower in EG compared to CG (P < .05, 7 studies for ARs; I2 = 54%). Fluoroquinolone antibiotics appear to improve inflammatory markers and may increase the cure rate for PID. Additionally, their incidence of adverse reactions seems lower compared to other treatments. While they show promising efficacy, safety concerns - such as tendon damage, cardiovascular issues, and neuropsychiatric effects - should be carefully considered, especially in at-risk populations. Given these risks and the variability in outcomes, further large-scale, long-term studies are needed to confirm their overall safety and efficacy. Future research should also identify the best patient populations for fluoroquinolone use and explore alternative treatments with comparable benefits and fewer risks.