Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial.

OBJECTIVE: To evaluate the equivalence of ceftriaxone plus doxycycline or azithromycin for cases of mild pelvic inflammatory disease (PID). METHODS: Patients with PID received an intramuscular injection of 250 mg of ceftriaxone, and were randomly assigned to receive 200 mg/d of doxycycline for 2 weeks, or 1 g of azithromycin per week, for 2 weeks. The degree of pain was assessed on days 2, 7, and 14 and clinical cure was assessed on day 14. RESULTS: From 133 patients eligible for the study, 13 were excluded for having conditions other than PID, 11 were lost on follow-up, and three had oral intolerance to the antibiotics, yielding 106 for protocol analysis. No significant difference was observed regarding the degree of pain between the doxycycline and azithromycin groups. Clinical cure per protocol was 98.2% (56 of 57; 95% confidence interval [CI], 0.9-0.99) with azithromycin, and 85.7% (42 of 49; 95% CI, 0.72-0.93) with doxycycline (P=0.02). In a modified intention to treat analysis, clinical cure was 90.3% (56 of 62; 95% CI, 0.80-0.96) with azithromycin, and 72.4% (42 of 58; 95% CI, 0.58-0.82) with doxycycline (P=.01); a relative risk of 0.35, and a number needed to treat of six for benefit with azithromycin. CONCLUSION: When combined with ceftriaxone, 1g of azithromycin weekly for 2 weeks is equivalent to ceftriaxone plus a 14-day course of doxycycline for treating mild PID.

Descompressão do saco endolinfático: análise da vertigem e da audição / Decompression of the endolymphatic sac: vertigo and hearing analysis

Introdução: A cirurgia na doença de Ménière está indicada quando a vertigem é refratária ao tratamento clínico. Vários procedimentos cirúrgicos foram propostos para o tratamento da vertigem nessa labirintopatia. Nesse trabalho nosso interesse foi pela descompressão do saco endolinfático. Objetivo: Analisar os resultados pós-cirúrgicos de 18 pacientes com doença de Ménière, em relação ao controle da vertigem e a melhora ou estabilização da audição, confrontar os nossos achados com os da literatura internacional e discutir aspectos de interesse relacionados a essa cirurgia. Método: Neste estudo retrospectivo, dezoito pacientes com diagnóstico de doença de Ménière, sem melhora da vertigem com o tratamento clínico, foram submetidos à descompressão do saco endolinfático. Analisamos no pós-operatório o controle da vertigem, a ausência e a diminuição da frequência, duração ou intensidade das crises e a melhora ou estabilização da audição. Resultados: O controle da vertigem ocorreu em 66% dos pacientes-ausência de vertigem em 11 (61%) e diminuição da frequência,duração ou intensidade em 1(5%). Observou-se melhora da audição em 4 pacientes (22,2%) e estabilização em 8 (44,5%). Nenhum paciente teve piora da audição em decorrência da cirurgia. Conclusão: A cirurgia de descompressão do saco endolinfático é útil para o tratamento da vertigem na doença de Ménière e deve ser indicada como um dos primeiros procedimentos cirúrgicos, principalmente em pacientes com perda leve ou moderada da audição, pelos resultados que costuma alcançar e pelo baixo risco de complicação. Obtivemos 66% de controle da vertigem e 22,2% de melhora da audição nos pacientes operados.

Introduction: Surgery in the Meniere's disease is indicated when the vertigo is refractory to clinical treatment. Many surgical procedures have been proposed for the treatment of vertigo in this labyrinthopathy. In this work we aimed at the decompression of the endolymphatic sac. Objective: To analyze the postoperative outcomes of 18 patients with Meniere's disease as for the control of the vertigo and the improvement or stabilization of hearing, to compare our findings with the international literature and discuss aspects of interest regarding this surgery. Method: In this retrospective study, eighteen patients with Meniere's disease diagnosis, without improvement of the vertigo with clinical treatment, were submitted to decompression of the endolymphatic sac. In the postoperative we analyzed the vertigo control, the absence and diminishing of frequency, duration or intensity of the crises and the improvement or stabilization of hearing. Results: The vertigo control occurred in 66% of the patients, absence of vertigo in 11 (61%) and diminishing of the frequency, duration or intensity in 1 (5%). We observed an improvement of hearing in 4 patients (22.2%) and stabilization in 8 (44.5%). No patient had worsening of hearing as a result of the surgery. Conclusion: The endolymphatic sac decompression surgery is helpful for the treatment of the vertigo in the Meniere's disease and must be indicated as one of the first surgical procedures, specially in patients with light or moderate hearing loss, for the results it usually achieves and the low risk of complication. We obtained 66% of vertigo control and 22.2% of hearing improvement in the patients operated.