Randomized prospective comparison of ampicillin and doxycycline in the treatment of acute pelvic inflammatory disease in hospitalized patients

This report describes a study in which women hospitalized for the treatment of acute pelvic inflammatory disease received doxycycline or ampicillin in a prospective, randomized, unblinded study. Forty-seven patients were enrolled in the study, including 13 with clinically apparent pelvic masses. Ampicillin was given to 23 patients including four with pelvic masses. Doxycycline was given to 24 patients including nine with pelvic masses. Among women who did not have pelvic masses, there was a favorable clinical response in 19 of 19 who received ampicillin and in 14 of 15 who received doxycycline (P = NS). The patients who had pelvic masses did less well (P = 0.0002). Favorable clinical responses were noted in three of four women who received ampicillin and in four of nine patients who received doxycycline (P = NS). These data indicate that the presence of a pelvic mass is predictive of an unfavorable response to treatment in women who have pelvic inflammatory disease. In pelvic inflammatory disease that is not complicated by the presence of a pelvic mass, doxycycline appears to be as effective as ampicillin.