Antibiotic therapy fights chronic endometritis

Chronic endometritis (CE) is infectious in nature and thus benefits from treatment with antibiotics, according to a study.

The study included 64 consecutive women with CE who received antibiotic therapy and another 64 CE patients who refused antibiotics (control). CE was diagnosed using hysteroscopy, histology, and immunohistochemistry for CD138.

All patients were tested for CE twice to evaluate the cure rate in both groups. Antibiotics were chosen based on endometrial culture (with antibiogram), with treatment repeated up to three times for patients with persistent disease.

In the antibiotic group, CE resolution occurred after a single treatment cycle in 20 patients (31.25 percent), after two cycles in 20 patients (31.25 percent), and after three cycles in 12 patients (19.35 percent). CE persisted in 12 patients (18.75 percent).

The primary outcome of cumulative cure rate of CE (defined as the percentage of patients without CE at the test of cure) was much higher among patients who received antibiotics versus no treatment (81.3 percent vs 6 percent). The same was true when comparing a single antibiotic cycle and no treatment (32.25 percent vs 6 percent).

Of note, the number of positive cases dropped across all testing modalities between the first and second evaluation. At the third evaluation, however, a decrease was seen only with hysteroscopy and CD138+ cell count but not with histology. The cumulative number of cases of CE diagnosed using hysteroscopy was significantly higher than with histology and immunohistochemistry.