Efficacy and safety of doxycycline in pelvic inflammatory disease: a systematic review and meta-analysis
Mezhevitinova E.A., Kepsha M.A., Ilyasova N.A., Zatevalov A.M.
Objective: To evaluate the clinical and microbiological efficacy, as well as the safety of doxycycline as part of combination therapy in women with pelvic inflammatory disease (PID).
Materials and methods: The systematic review and meta-analysis were conducted in accordance with the PRISMA checklist. The analysis included randomized controlled trials published from 1967 to June 2025 that assessed the efficacy and safety of doxycycline in various treatment regimens for PID in women aged over 18 years. An electronic search was conducted in PubMed, Cochrane Library, Google Scholar, and ClinicalTrials.gov. The risk of bias was assessed using the RoB-2 tool.
Results: The qualitative and quantitative analysis included eight randomized clinical trials with a total of 1,881 patients. The meta-analysis revealed that clinical efficacy of doxycycline was comparable to that of alternative treatment regimens (OR=1.17; 95% CI [0.91; 1.49]; p=0.22). However, microbiological efficacy was significantly higher in the doxycycline group (OR=1.40; 95% CI [1.14; 1.72]; p=0.002). Adverse events, mainly related to the gastrointestinal tract, were more frequently observed in regimens including doxycycline, presumably due to the use of its hydrochloride form.
Conclusion: Doxycycline, especially in the form of monohydrate, is an effective and rational component of combination therapy for women with PID, as it provides high microbiological eradication rates with acceptable tolerability. Further research with standardized outcome criteria and extended follow-up is required to clarify its role in therapeutic algorithms.
Authors’ contributions: Kepsha M.A., Ilyasova N.A. – developing the concept and design of the study, literature search and analysis, manuscript writing, approval of the final version of the article; Zatevalov A.M. – statistical data processing; Mezhevitinova E.A. – editing the text, approval of the final version of the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interest.
Funding: The study was conducted without sponsorship.
For citation: Mezhevitinova E.A., Kepsha M.A., Ilyasova N.A., Zatevalov A.M. Efficacy and safety of
doxycycline in pelvic inflammatory disease: a systematic review and meta-analysis.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (7): 27-38 (in Russian)
https://dx.doi.org/10.18565/aig.2025.176
Keywords
doxycycline
pelvic inflammatory disease
PID
antibacterial therapy
doxycycline monohydrate
dispersible tablets
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Received 30.06.2025
Accepted 11.07.2025
About the Authors
Elena A. Mezhevitinova, Dr. Med. Sci., Leading Researcher at the Scientific and Outpatient Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Ac. Oparin str., Moscow, 117997, Russia, mejevitinova@mail.ru,https://orcid.org/0000-0003-2977-9065
Maria A. Kepsha, Junior Researcher, Physician at the Scientific and Outpatient Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Ac. Oparin str., Moscow, 117997, Russia, m_kepsha@oparina4.ru, https://orcid.org/0000-0002-4201-1360
Natalya A. Ilyasova, Researcher at the Department of International Cooperation, Obstetrician-Gynecologist at the Scientific and Outpatient Department, V.I. Kulakov
National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Ac. Oparin str., Moscow, 117997, Russia,
natalia_ilyasova@mail.ru, https://orcid.org/0000-0003-0665-3515
Alexander M. Zatevalov, PhD, Senior Researcher at the Laboratory of Systems Biology of Aging and Geroprotective Technologies, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 4 Ac. Oparin str., Moscow, 117997, Russia; Deputy Director for Innovation Development and Technology, G.N. Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology, Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), 10 Admiral Makarov str., Moscow, 125212, Russia, a_zatevalov@oparina4.ru, https://orcid.org/0000-0002-1460-4362
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