Antibiotics or antibiotic combinations for chronic endometritis：a network meta-analysis

Background:Chronic endometritis is a persistent and localized inflammation of the endometrium. Clinically, antibiotics are used to treat CE, but there is a lack of optimal treatment protocols. Objectives:To evaluate the effectiveness and safety of different regimens for the treatment of chronic endometritis using a network meta-analysis. Search Strategy:A computerized search was conducted across multiple databases, including PubMed, Embase, Cochrane Library, Web of Science, Wanfang, VIP, CBM, and CNKI, for all clinical studies on antibiotics or antibiotic combinations for the treatment of chronic endometritis. The search covered studies published from January 1, 2019, to September 6, 2024. Selection Criteria:Following the independent screening of the literature by two evaluators, data extraction and risk of bias assessment were performed. Data Collection and Analysis:A network meta-analysis was carried out using Stata 14.0 software, and ranking and funnel plots were generated. Main Results:A total of five studies involving 887 patients were included. Four treatment regimens were assessed: Doxycycline; Doxycycline and Dydrogesterone; Levofloxacin and Tinidazole; Doxycycline and Prednisone acetate. The network meta-analysis revealed that Levofloxacin and Tinidazole were the most effective in terms of overall efficacy, while Doxycycline and Prednisone acetate demonstrated the best outcomes in terms of pregnancy and miscarriage rates. Conclusions:All four drug regimens show good clinical efficacy for treating chronic endometritis, with Levofloxacin and Tinidazole being the most effective. Treatment choices should be individualized based on patient-specific needs. However, due to the limited number of included studies and small sample sizes, further large-scale, high-quality clinical trials are necessary to validate these findings.