***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This multicenter , prospect i ve , double-blind study compared the safety and efficacy of clindamycin and ciprofloxacin versus ceftriaxone and doxycycline in the treatment of out patients with mild to moderate pelvic inflammatory disease ( PID ) diagnosed by laparoscopy . Sample s taken from the endocervix , endometrium , and abdominal cavity before treatment and from the endocervix after treatment were cultured for aerobes , anaerobes , Neisseria gonorrhoeae , and Chlamydia trachomatis . Of the 138 patients enrolled , 131 were evaluable for efficacy . The most prevalent bacteria were streptococci , staphylococci , and Escherichia coli ( among aerobes ) and Bacteroides species and peptostreptococci ( among anaerobes ) . N. gonorrhoeae was present in 2 % ( 3 ) of the 131 evaluable patients , and C. trachomatis was in 11 % ( 15 ) . The clinical cure rate was 97 % ( 65 of 67 ) in the clindamycin and ciprofloxacin group and 95 % ( 61 of 64 ) in the ceftriaxone and doxycycline group . Side effects were similar in both groups . In conclusion , the two regimens for the outpatient treatment of mild to moderate PID were similarly effective and safe Eighty-two patients with laparoscopically confirmed salpingitis were r and omly divided into two groups in a multicentre and prospect i ve trial . Single drug therapy with the amoxicillin-clavulanic acid combination was used in 42 patients ( group A ) . The other 40 patients were given a combination of penicillin , aminoside and metronidazole ( group B ) . For each case a secondary prescription for a tetracycline was discussed . Clinical results were comparable in both groups : sooner ( at the end of the hospitalization period ) in group A : 10 cured , 30 improved and 2 failures against 9 cured , 30 improved in group B. Later ( evaluation after 5 to 8 weeks ) a relapse was noted in five patients in group A and included one case of angioedema in group B. It is concluded that amoxicillin-clavulanic acid combination is a satisfactory alternative to the penicillin-aminoside-metronidazole combination , especially as it is simpler to use Objective : This multinational , multicentre , prospect i ve , r and omised , double blind , parallel group , non-inferiority study compared the efficacy and safety of moxifloxacin monotherapy with ofloxacin plus metronidazole in women with uncomplicated pelvic inflammatory disease . Methods : Women from hospitals throughout 13 countries received a 14 day course of either oral moxifloxacin , 400 mg once daily ( n = 384 ) , or oral ofloxacin , 400 mg twice daily plus oral metronidazole , 500 mg twice daily ( n = 365 ) . Results : Of the 741 patients in the intent to treat ( ITT ) population , 564 ( 74.2 % ) were valid for the per protocol ( PP ) analyses ; 112 ( 19.9 % ) of these were included in the microbiologically valid population ( MBV ) . Clinical resolution rates in the PP population at the test of cure visit ( TOC , 5–24 days post-therapy , primary efficacy end point ) were 90.2 % ( 248/275 ) for moxifloxacin and 90.7 % ( 262/289 ) for ofloxacin plus metronidazole ( 95 % CI : −5.7 % to 4.0 % ) . At follow up ( 28–42 days post-therapy ) , resolution rates in the PP population were 85.8 % ( 236/275 ) and 87.9 % ( 254/289 ) for moxifloxacin and comparator , respectively ( 95 % CI : −8.0 % to 3.1 % ) . Bacteriological success rates in the MBV population at TOC were 87.5 % ( 49/56 ) for moxifloxacin and 82.1 % ( 46/56 ) for comparator ( 95 % CI : −8.3 % to 18.8 % ) . Against Chlamydia trachomatis and Neisseria gonorrhoeae , bacteriological success rates with moxifloxacin were 88.5 % ( 23/26 ) and 100 % ( 13/13 ) and for comparator 85.7 % ( 18/21 ) and 81.8 % ( 18/22 ) , respectively . Drug related adverse events occurred less frequently with moxifloxacin ( 22.5 % ( 85/378 ) ) versus the comparator ( 30.9 % ( 112/363 ) ) ( p = 0.01 ) . Conclusion : In uncomplicated PID , once daily moxifloxacin monotherapy was clinical ly and bacteriologically as efficacious as twice daily ofloxacin plus metronidazole therapy and was associated with fewer drug related adverse events Sixty patients with acute uncomplicated pelvic infection were treated with cefoxitin or ampicillin alone , the purpose being to show that a relatively cheap antimicrobial agent ( ampicillin ) could be used . The groups ( 30 patients in each ) were clinical ly comparable ( P greater than 0,01 - -Hotelling T-square test ) . In the first group 2 g ampicillin was administered intravenously on admission followed by 1 g intravenously 4-hourly , and in the second group 2 g cefoxitin was administered intravenously on admission followed by 1 g intravenously every 8 hours . A good response was obtained in both groups . On the basis of cost ampicillin would seem to be the treatment of choice in uncomplicated acute pelvic infection A prospect i ve , r and omized , controlled , non-blind clinical trial was conducted to compare the efficacy of monotherapy with ciprofloxacin with that of a combination of clindamycin plus gentamicin in the treatment of patients with acute pelvic inflammatory disease . Pretreatment and post-treatment cervical culture specimens were obtained for Neisseria gonorrhoeae , Chlamydia trachomatis , Mycoplasma hominis , and Ureaplasma urealyticum . Pretreatment and post-treatment endometrial culture specimens were obtained for those organisms plus facultative and anaerobic bacteria . Minimal inhibitory concentrations were determined on all isolates by agar dilution . Clinical resolution of infection was seen in 31 of 33 ( 94 percent ) ciprofloxacin-treated patients compared with 34 of 35 ( 97 percent ) clindamycin/gentamicin-treated patients . N. gonorrhoeae was eradicated in all cases and C. trachomatis in 12 of 13 cases ( 92 percent ) . Ciprofloxacin appeared less effective than  clindamycin/gentamicin  in eradicating bacterial-vaginosis-associated organisms from post-treatment culture specimens obtained from the endometrium . Comparable clinical response was seen with both regimens . The significance of persistent bacterial-vaginosis-associated organisms following ciprofloxacin therapy is unclear . However , since one goal of treatment of pelvic inflammatory disease should be to eliminate organisms from the upper genital tract , ciprofloxacin may not provide optimal single-agent therapy for pelvic inflammatory disease In this prospect i ve trial , 130 hospitalized patients with acute pelvic inflammatory disease based on clinical criteria were r and omly treated with intravenous gentamicin plus clindamycin ( N=63 ) or cefoxitin plus doxycycline ( N=67 ) for at least 4 days , followed by oral clindamycin or doxycycline , respectively , for a total of 14 days . Pre-treatment cultures were obtained for endocervical Neisseria gonorrhoeae and Chlamydia trachomatis , and for endometrial C trachomatis and aerobic and anaerobic bacteria . Overall , 46 subjects ( 35 % ) had endocervical cultures positive for N gonorrhoeae .  Endocervical and endometrial cultures were positive for C trachomatis in 16 and 6 % , respectively . Ninety-five percent of patients had at least one aerobic bacterium , 38 % had at least one anaerobic bacterium , and only 2 % had no organisms isolated from their endometrium . Fifty-seven subjects taking gentamicin-clindamycin ( 90.5 % ) and 64 subjects taking cefoxitin-doxycycline ( 95.5 % ) were clinical ly cured , a nonsignificant difference . Three subjects treated with gentamicin- clindamycin and one treated with cefoxitindoxycycline required hysterectomy or salpingectomy for cure . Follow-up examinations and cultures were performed in 84 % of the subjects . Post-treatment cultures for N gonorrhoeae were negative in all cases tested . Post-treatment endocervical and endometrial C trachomatis cultures were negative in ten of 11 subjects treated with gentamicinclindamycin and in eight of nine treated with cefoxitindoxycycline , a nonsignificant difference . We conclude that gentamicin-clindamycin and cefoxitin-doxycycline have similar clinical cure rates for acute pelvic inflammatory disease and are equivalent in eradicating genital N gonorrhoeae and C A prospect i ve , r and omized study of intravenous followed by oral ciprofloxacin compared with the combination of intravenous clindamycin and gentamicin was conducted in 122 women hospitalized with pelvic infections . Clinical diagnoses included endometritis ( 97 patients ) and uncomplicated pelvic inflammatory disease ( 25 patients ) .  Treatment successes for endometritis included 42 of 50 ( 84 percent ) patients treated with ciprofloxacin compared with 35 of 47 ( 75 percent ) treated with the clindamycin-gentamicin combination .  Treatment successes for acute salpingitis included 10 of 10 ( 100 percent ) treated with ciprofloxacin and 13 of 15 ( 87 percent ) treated with clindamycin-gentamicin . Ciprofloxacin  successfully eradicated Chlamydia trachomatis in 11 of 12 patients as did clindamycin-gentamicin in six of seven patients . In this study of pelvic infection , ciprofloxacin demonstrated efficacy comparable with the combination of clindamycin and gentamicin , and is effective against C. trachomatis Sixty-two women were r and omized in a double-blind fashion to receive one of two antibiotic regimens for the treatment of clinical ly diagnosed pelvic inflammatory disease . Thirty of .31 patients ( 96.8 % ) receiving a combination of cefoxitin with doxycycline and 28 of 31 ( 90.3 % ) receiving a combination of clindamycin with amikacin  responded to therapy ( P = not significant ) . Chlamydia trachomatis , Neisseria gonorrhoea , or both were isolated from 13.3 , 7.0 , and 4.8 % of patients , respectively . Of the four patients not responding to therapy , all had inflammatory complexes .  Cefoxitin/doxycycline and clindamycin/amikacin are both effective in the treatment of pelvic inflammatory disease This six-center , prospect i ve , open-label clinical trial compared the efficacy and safety of three regimens recommended by the Centers for Disease Control and Prevention ( CDC ) for the treatment of women hospitalized for acute pelvic inflammatory disease ( PID ) . The study focused on the response to inpatient therapy , not on long-term prevention of sequelae . A severity score was used for objective comparison of the degree of illness before and after therapy . Women were r and omly assigned ( in a 1:1:1 ratio ) to treatment with cefoxitin plus doxycycline , clindamycin plus gentamicin , or cefotetan plus doxycycline . Two hundred seventy-five ( 94.2 % ) of 292 evaluable women required no alteration in therapeutic regimen . The three regimens produced almost identical cure rates . No serious adverse clinical or laboratory events were observed . In short , the three regimens recommended by the CDC for inpatient therapy of acute PID were similarly effective and safe The vaginal douching habits of 100 consecutive municipal hospital patients with verified pelvic inflammatory disease ( cases ) were compared with those of 762 r and omly selected controls ( r and om controls ) and 119 women thought to have pelvic inflammatory disease but in whom the diagnosis was not confirmed by laparoscopy and /or endometrial biopsy specimen ( internal controls ) . Because patients had been symptomatic for no more than 3 weeks , current douching was arbitrarily defined as any douching during the previous 2 months . Current douching was more common among 
    Output:
    
In this systematic review , we present information relating to the effectiveness and safety of the following interventions : antibiotics ( oral , parenteral , different duration s , different regimens ) and routine antibiotic prophylaxis ( before intrauterine device insertion in women at high risk or low risk )