Evidence-based Evaluation Of The Effect Of Loading Chinese Patent Medicines On The Use Of Antibiotics In The Treatment Of Pelvic Inflammatory Disease

ObjectiveTo explore the potential effect of combined Chinese patent medicine(CPM)on antibiotic use for patients with pelvic inflammatory disease(PID),thus providing a reference for integrative Chinese and western therapy on PID.Through applying the qualitative methods and to determine the attitudes and views of gynecologists on drug combination,to deeply describe the experience of clinical gynecologists using antibiotics and Chinese patent medicine on pelvic inflammatory diseases(PID)and provide comprehensive evidence on PID evidence-based integrated treatment.MethodProgress and problems in diagnosis and treatment of pelvic inflammatory diseases based on comparison of domestic and foreign guidelinesGuidelines were identified by a search of common electronic databases(CNKI,CQVIP,Wanfang and pubmed)and web sites of relevant societies and organizations,as of February 17,2020.Then analyzed and compared the diagnostic criteria,treatment principles,antibacterial drug regimens,drug-resistant and adverse reactions of PID,and sorted out the problems.The effect of the combined use of Chinese patent medicine on the antibiotic use for Pelvic Inflammatory Disease:A systematic review and meta-analysisOur review did a comprehensive retrieve till May 17,2020 in China National Knowledge Infrastructure,Wanfang Database,Chongqing VIP,SinoMed,the Cochrane library,and clinical trial registers such as the World Health Organization(WHO)International Clinical Trials Registry Platform,the Chinese clinical trial registry,and the Clinical Trials.gov.Randomized controlled trials(RCTs)and quasi-randomized controlled trials(quasi-RCTs)on the combination of CPM and antibiotics compared to antibiotics alone for the effect on the usage of antibiotics were included.After removal of duplicates,two authors independently screened retrieved literature and extracted data through a predefined Excel data extraction table.We used Risk of Bias(ROB)2.0 for quality assessment and RevMan 5.4 software to synthesis the data.Qualitative study of antibiotics loaded Chinese patent medicines in the treatment of pelvic inflammatory diseasesEleven gynecologists from general hospitals and traditional Chinese medicine hospitals with junior to senior titles were selected by the purposive sampling.Then,the individual depth interview was carried out by applying a semi-structured interview guideline.The theme analysis was used in material qualitative study.ResultsProgress and problems in diagnosis and treatment of pelvic inflammatory diseases based on comparison of domestic and foreign guidelinesEight latest PID guidelines be included:China Western medicine,Traditional Chinese medicine(TCM),Chinese patent medicine,France,CDC,ACOG,BASHH,and European STI.For the diagnostic criteria,both domestic and foreign guidelines support keeping the threshold for diagnosing PID at a low level.The TCM guidelines determine classifications and treatment rules based on the diagnostic criteria of TCM and Western medicine(WM);The guidelines are consistent with the broad-spectrum antibiotic combination treatment,but the medication and course of treatment are not exactly the same.In addition,foreign guidelines all mention antimicrobial resistance and adverse reactions.The TCM Guidelines regulates the practics of TCM and proposes the principle of integrated TCM and WM(CDC):TCM alone/combined antibiotics.However,the practice of TCM alone still lacks sufficient high-quality evidence.We have not found any specific prescription recommendations or guidelines for integrating TCM and WM.The effect of the combined use of Chinese patent medicine on the antibiotic use for Pelvic Inflammatory Disease:A systematic review and meta-analysisFifteen trials(six quasi-RCTs and nine RCTs)involving 1628 participants were included.There were 11 trials reported the effect of combined PCM on the time of antibiotic use,showing that the average time was shortened,while the time in 7 trials were reported shorter than the suggested course on Chinese PID western medicine guideline(14 days).The 11 trials involved 5 different kinds of CPM and 3 schemes of antibiotics.Meta-analysis were performed on trials with the same intervention.A pooled result from 3 trials showed that comparing with moxifloxacin alone,combined Fukang Xiaoyan suppository had a positive effect in reducing the time of antibiotic use(MD=-5.73 days,95%CI-6.32 to-5.14,three trials involving 246 participants).On the aspect of decreasing the dosage for antibiotic,two trials indicated that the CPM group had a potential over the control group.Two trials reported the effect of CPM in reducing the types of antibiotic use,showing that the kinds of antibiotics were decreased due to the combination use of CPM.All trials showed that the combined CPM group was superior to the antibiotic group in increasing the cure rate and reducing the recurrence rate.All the 15 studies were assessed as high risk of bias.Qualitative study of antibiotics loaded Chinese patent medicines in the treatment of pelvic inflammatory diseasesFour themes with 13 sub-themes and 420 initial codes emerged after the analysis including PID characteristics,cognition to guidelines,current situation and characteristics of antibiotic usage,and current situation and reason of antibiotic combined with Chinese patent medicine.PID may be converted to sequelae of PID(SPID)or acute conditions;the former is more common.The efficacy of PID treatment firstly focuses on the symptoms,followed by blood routine and other laboratory tests.With respect to the use of guidelines,there is controversy among gynecologists as to whether to follow the guidelines or to be flexible.The use of antibiotics is limited by medical environment and policy,and there are concerns about side effects,sequelae and drug resistance.At present,the use of Chinese patent medicine exists at all times,and it is mainly applied to the non-acute stage of PID and to the SPID patients.It can be seen clinically that some gynecologists use Chinese patent medicine to reduce the course of antibiotic usage,but there is a lack of high-certainty evidence to support it.ConclusionAntibiotic therapy protocols from China lack content of antimicrobial resistance;The advantages of integrating TCM and WM in the treatment of PID in China are obvious,but more evidence is needed;.It is necessary to formulate specific therapy protocols for organically integration of TCM and western medicine,based on the evidence from China's local antibiotic program.[1]Low certainty evidence demonstrated that,CPM combined with antibiotics on patients with PID might shorten the length,decreasing the dosage,and lessen the varieties of antibiotic use.More high-quality trials are needed to verify this conclusion in the future.It is suggested that further study should be carried out in the future to explore the specific time,mechanism and opportunity of antibiotic use,so as to obtain the best treatment scheme of integrated traditional Chinese and western medicine.Gynecologists'application and cognition on drug combination of antibiotics and Chinese patent medicine are related to the PID characteristics,guideline recommendations,characteristics and limitations of antibiotics and Chinese medicines,medical environment,and policy restrictions.Gynecologists' understanding of drug resistance should be deepened,and further clinical studies are still needed to provide high-quality clinical evidence for the formulation of the combined use of antibiotics and traditional Chinese medicine.